High-dose chemotherapy with granulocyte colony-stimulating factor in advanced and/or metastatic soft tissue sarcomas

It is well known that the treatment of patients with locally advanced and/or metastatic soft tissue sarcomas is in most cases merely palliative, remaining overall survival very poor [1]. As in other advanced tumors, several clinicalbiologic parameters have been tested as possible prognostic factors in the outcome of disease [2, 3, 4, 5]. At today, it is not yet known if the type of clinical response to chemotherapy could modify prognosis in these patients, but is general opinion that the achievement of an objective response (expecially complete response) may be, also in advanced and/or metastatic stage, an important factor for survival. With regard to soft tissue sarcomas, a dose-response relationship is suggested for Doxorubicin [6, 7] or his analogue Epidoxorubicin [8, 9], although with an increased cardiotoxicity. Similarly, in a review performed on the efficacy of Ifosfamide (a new effective drug more recently introduced in the management of sarcoma patients) combined with anthracyclines, the highest percentage of responses were reported in studies using the higher doses of Doxorubicin or Epidoxorubicin [10]. On the other hand, an increase of the administered dose of chemotherapy has been demonstrated effective in enhance the response in different tumours, also in advanced or metastatic stage [11]. However, in all reported experiences, the major limiting factor for dose escalation is the increasing in overall toxicity, both cardiac and haematologic.