Would soft tissue sarcoma need a chemotherapy? 

For two decades, this topic has been a non-stop discussion and concern globally in the osteosarcoma medical community. Unlike the chemotherapy for many common malignant 'bone' tumors, such as osteosarcoma and Ewing's sarcoma, which is usually very effective, chemotherapy for ‘soft’ tissue sarcoma has great variation. The main difference is the tumor category. We organized it in the table below. 
 

＊ Imaging of soft tissue tumors, 3rd edn. Berlin: Springer; 2006. p. 107–16
 

However, it is important to note that the above information is a 'statistical' result and does not represent the real situation completely. In some patients, excellent results may occur in the tumor that most patients don’t have effectiveness due to the individual differences

Chemotherapy for soft tissue sarcoma can be divided into Neoadjuvant Chemosensitivity and Adjuvant Chemosensitivity, depending on the time to give the drug. The difference between the two lies in the time point at which chemotherapy is given. Neoadjuvant chemosensitivity is given 'before’ the surgery, while adjuvant chemosensitivity is the treatment given 'after' the surgery. The choices and purposes of the two chemotherapies are described below:

The most important purposes of neoadjuvant chemotherapy are two:
First, to drive the necrosis of soft tissue sarcoma and reduce the tumor size before surgery. This allows surgeons to cut the tumor cleaner and safer during the operation.
Second, to remove the tumor cells that possibly have metastasized everywhere before surgery, reducing the chance of distant metastasis.
 

Although neoadjuvant chemotherapy has these advantages, generally, we are less likely to recommend neoadjuvant chemotherapy for patients with soft tissue sarcoma in clinical situations. The reason, as mentioned above, is that most soft tissue sarcomas do not respond significantly to chemotherapy. When we give neoadjuvant chemotherapy (two to four months), the patients are exposed to the risk of increased tumor size because of the not yet been performed surgery.
 
Therefore, we recommend pre-surgical neoadjuvant chemotherapy for patients with soft tissue sarcoma only in exceptional circumstances:
First, highly malignant soft tissue sarcoma with significantly large tumor size that the surgeon can't judge whether it can't be surgically removed completely. We hope that neoadjuvant chemotherapy could reduce the tumor size so that orthopedic surgeons could remove the tumor cleanly.
Second, highly malignant soft tissue sarcoma with poor sensitivity to chemotherapy and close growth near important organs, such as important nerves, large blood vessels, bladder, intestines, and so on. We hope that neoadjuvant chemotherapy could shrink the tumor so that orthopedic surgeons could remove the tumor clearly while retaining those vital organs.

The most important purposes of adjuvant chemotherapy are two:
First, to reduce the local recurrence rate after the surgical removal of soft tissue sarcoma.
Second, to remove the tumor cells that possibly have metastasized everywhere, reducing the chance of distant metastasis.


Same as the description for neoadjuvant chemotherapy, generally in the clinical situation, we also do not often recommend post-surgical adjuvant chemotherapy for patients with soft tissue sarcoma, although it has those advantages mentioned above. However, unlike the case of neoadjuvant chemotherapy, the tumor has been removed when we determine the application of adjuvant chemotherapy. Hence, we have less concern about the continuous growth of tumors if the chemotherapy doesn’t work well, and we’ll have more flexibility when we make the judgment. Currently, there are no worldwide guidelines for adjuvant chemotherapy for soft tissue sarcoma.

Generally, in several conditions, we would recommend patients to bear months of adjuvant chemotherapy after surgery:
First, a highly malignant soft tissue sarcoma that has a certain sensitivity to chemotherapy and larger tumor size before surgery.
Second, a highly malignant soft tissue sarcoma with a certain sensitivity to chemotherapy and the surgeons determine a higher recurrence likelihood during surgery.
Third, a highly malignant soft tissue sarcoma that has a certain sensitivity to chemotherapy and combined with other distant metastasis, such as lungs, lymphatic, etc

At present, there is no conclusion on the chemotherapy for soft tissue sarcoma. Physicians will evaluate many aspects when recommending chemotherapy. So it's important to communicate, discuss, and trust your doctor!