CONTRIBUTIONS FROM SURGEONS TO CLINICAL-TRIALS AND RESEARCH ON THE MANAGEMENT OF SOFT-TISSUE SARCOMA

Background: Surgical resection is the primary treatment for soft tissu e sarcoma. Surgeons are in a position to develop and define appropriat e treatment strategies for this disease. In an effort to define the co ntributions of surgeons to the management of sarcoma, the surgical and clinical oncology literature from January 1983 through June 1996 was reviewed. Methods: A computerized literature search of the Cancerlit d atabase for January 1983 to June 1996 was performed. The search was li mited to the topic of soft tissue sarcoma and was further confined to 15 journals that publish articles relevant to surgical management. The se studies were then categorized by multiple parameters and analyzed. Results: The Cancerlit file contained 4478 articles in which sarcoma w as the primary topic. When the search was limited to 15 journals frequ ently read by surgeons, 479 references (11%) were retrieved. Within th e surgical literature, 95 of the 479 articles (20%) described prospect ive studies, of which 33 were prospective and randomized. These studie s represent all but three of the prospective randomized trials within the literature during the time period reviewed. The management of pati ents with sarcoma was evaluated in 26 of the prospective randomized tr ials; of these, 13 trials evaluated adjuvant chemotherapy, three evalu ated adjuvant radiotherapy, and ten evaluated the chemotherapeutic tre atment of metastatic disease. Surgical oncologists were the first or s enior author on 10 of the 16 prospective randomized studies regarding adjuvant radiation or chemotherapy. Four of the 16 trials evaluating a djuvant therapy contained more than 100 patients, and three of those f our were from cooperative group efforts. All but one of the studies of adjuvant therapy with less than 100 patients were from single institu tional trials. Conclusions: Although the surgical and clinical oncolog y literature on soft tissue sarcoma is composed primarily of retrospec tive reviews, the prospective randomized trials reported represent alm ost all of the randomized trials in the literature and have significan t contributions from surgeons. Surgeons can guide and design clinical trials, but overall patient accrual as represented by soft tissue sarc oma is low, and may be improved through cooperative group efforts.