Zusammenfassung.
Weichteilsarkome gehören zu den selteneren malignen Neoplasien. Der Trend in der Therapie der letzten Jahre geht in Richtung auf weniger mutilierende Behandlungen. Die Integration von Chirurgie und Strahlentherapie innerhalb multimodaler Therapiekonzepte kann auf verschiedene Art und Weise realisiert werden. Die Indikation zur Strahlentherapie wird in Abhängigkeit von Tumorgröße, Tumorsitz, Grading und dem Status des Resektionsrandes gestellt. Die Bestrahlung kann präoperativ, intraoperativ, postoperativ oder definitiv erfolgen. Sie wird entweder perkutan oder als Brachytherapie appliziert. Auf diese Weise ist eine hohe Rate des Extremitätenerhalts, des krankheitsfreien Überlebens und des Gesamtüberlebens möglich.
The integration of radiation therapy into multimodal therapeutic strategies for soft tissue sarcomas.
Soft tissue sarcomas are rare malignant neoplasias. During the last years the trend in the therapy is to favor less mutilating treatments. The integration of surgery and radiation therapy for multimodality treatment can be realised in different ways. The indication for radiation therapy depends on tumor size, tumor location, grading and the state of the pathologic margin. Radiation may be applied preoperatively, intraoperatively, postoperatively or as the primrary treatment. It may be delivered percutaneously or by means of brachytherapy. Thus high rates of extremity preservation, disease-free survival and overall survival are achievable.
Schlüsselwörter:
Weichteilsarkom - Strahlentherapie - Multimodale Therapiekonzepte - Brachytherapie
Key words:
Soft tissue sarcoma - Radiation therapy - Multimodality treatment - Brachytherapy
Literatur
-
1
Alekhteyar K M, Leung D H, Brennan M F, Harrison L B.
The effect of combined external beam radioatherapy on local control and wound complications in patients with high-grade soft tissue sarcomas of the extremity with positive margins.
Int J Radiat Oncol Biol Phys.
1996;
36
321-324
-
2
Alektiar K M, Hu K, Anderson L, Brennan M F, Harrison L B.
High-dose rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas.
Int J Radiat Oncol Biol Phys.
2000;
47
157-163
-
3
Alektiar K M, Velasco J, Zelefsky M J, Woodruff J M, Lewis J J, Brennan M F.
Adjuvant radiotherapy for margin-positive high-grade soft tissue sarcoma of the extremity.
Int J Radiat Oncol Biol Phys.
2000;
48
1051-1058
-
4
Alektiar K M, Zelefsky M J, Brennan M F.
Morbidity of adjuvant brachytherapy in soft tissue sarcoma of the extremity and superficial trunk.
Int J Radiat Oncol Biol Phys.
2000;
47
1273-1279
-
5
Arbeit J M, Hilaris B S, Brennan M F.
Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas.
J Clin Oncol.
1987;
5
480-488
-
6
Barkley H T, Martin R G, Romsdahl M M, Lindberg R, Zagars G K.
Treatment of soft tissue sarcomas by preoperative irradiation and conservative surgical resection.
Int J Radiat Oncol Biol Phys.
1988;
14
693-699
-
7
Brant T H, Parsons J T, Marcus R B, Spanier S S, Heare T C, van der Griend R A, Enneking W F.
Million RR. Preoperative irradiation for soft tissue sarcomas of the trunk and extremities in adults.
Int J Radiat Oncol Biol Phys.
1990;
19
899-906
-
8 Budach V, Bamberg M, Budach W, Dunst J, Rühl U, Seegenschmidt M H, Schmitt G. Strahlentherapie von Weichteilsarkomen im Erwachsenenalter. In: Haase W, Hess CF, Kamprad F, Molls M, richter J, Seegenschmidt MH, Schnabel K (eds) Leitlinien in der Radioonkologie. Vol. R5. Tübingen; Deutsche Gesellschaft für Radioonkologie 1999: 1-9
-
9
Bujko K, Suit H D, Springfield D S, Convery K.
Wound healing after preoperative radiation for sarcoma of soft tissues.
Surg Gynecol & Obstet.
1993;
176
124-134
-
10
Cheng E Y, Dusenbery K E, Winters M R, Thompson R C.
Soft tissue sarcomas: preoperative versus postoperative radiotherapy.
J Surg Oncol.
1996;
61
90-99
-
11
Dinges S, Budach V, Budach W, Feldmann H J, Stuschke M, Sack H.
Local recurrences of soft tissue sarcomas in adults: a retrospective analysis of prognostic factors in 102 cases after surgery and radiation therapy.
Eur J Cancer.
1994;
11
1636-1642
-
12
Fein D A, Lee W R, Lanciano R M, Corn B W, Herbert S H, Hanlon A L, Hoffman J P, Eisenberg B L, Coia L R.
Management of extremity soft tissue sarcomas with limb-sparing surgery and postoperative irradiation: do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control?.
Int J Radiat Oncol Biol Phys.
1995;
32
969-976
-
13
Geer R J, Woodruff J, Casper E S, Brennan M F.
Management of small soft-tissue sarcoma of the extremity in adults.
Arch Surg.
1992;
127
1285-1289
-
14
Giuliano A E, Eilber F R.
The rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas.
J Clin Oncol.
1985;
3
1344-1348
-
15
Gunderson L L, Nagorney D M, McIlrath D C, Fieck J M, Wieand H S, Martinez A, Pritchard D J, Sim F, Martenson J A, Edmonson J H, Donohue J H.
External beam and intraoperative electron irradiation for locally advanced soft tissue sarcomas.
Int J Radiat Oncol Biol Phys.
1993;
25
647-656
-
16
Harrison L B, Franzese F, Gaynor J J, Brennan M F.
Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk.
Int J Radiat Oncol Biol Phys.
1993;
27
259-265
-
17
Keus R B, Rutgers E JT, Ho G H, Gortzak E, Albus-Lutter C E, Hart A AM.
Limb-sparing therapy of extremity soft tissue sarcomas: treatment outcome and long-term functional results.
Eur J Cancer.
1994;
30A
1459-1463
-
18
Kishi K, Sonomura T, Sato M.
Radiotherapy for hypoglycaemia associated with large leiomyosarcomas.
Br J Radiol.
1997;
70
306-308
-
19
Lawrence W T, Zabell A, McDonald H D.
The tolerance of skin grafts to postoperative radiation therapy in patients with soft-tissue sarcoma.
Ann Plast Surg.
1986;
16
204-210
-
20
Le Pechoux C, Le Deley M-C, Delaloge S, Latigau E, Levy-Piedbois C, Bonvalot S, Le Cesne A, Missenard G, Terrier P, Vanel D, Genin J, Fontaine F.
Postoperative radiotherapy in the management of adult soft tissue sarcoma of the extremities: results with two different total dose, fractionation, and overall treatment time schedules.
Int J Radiat Oncol Biol Phys.
1999;
44
879-886
-
21
Lehnert T, Schwarzbach M, Willeke F, Treiber M, Hinz U, Wannenmacher M M, Herfarth C.
Intraoperative radiotherapy for primary and locally recurrent soft tissue sarcoma: morbidity and long-term prognosis.
Eur J Surg Oncol.
2000;
26A
21-24
-
22
Lindberg R D, Martin R G, Romsdahl M M, Barkley H T.
Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas.
Cancer.
1981;
47
2391-2397
-
23
Mundt A J, Awan A, Sibley G S, Simon M, Rubin S J, Samuels B, Wong W, Beckett M, Vijayakumar S, Weichselbaum R R.
Conservative surgery and adjuvant radiation therapy in the management of adult soft tissue sarcoma of the extremities: clinical and radiobiological results.
Int J Radiat Oncol Biol Phys.
1995;
32
977-985
-
24
Nag S, Shasha D, Janjan N, Petersen I, Zaider M.
The American brachytherapy society recommendations for brachytherapy of soft tissue sarcomas.
Int J Radiat Oncol Biol Phys.
2001;
49
1033-1043
-
25
Nielsen O S, Cummings B, O'Sullivan B, Catton C, Bell R S, Fornarsier V L.
Preoperative and postoperative irradiation of soft tissue sarcomas: effect on radiation field size.
Int J Radiat Oncol Biol Phys.
1991;
21
1595-1599
-
26
Ormsby M V, Hilaris B S, Nori D, Brennan M F.
Wound complications of adjuvant radiation therapy in patients with soft-tissue sarcomas.
Ann Surg.
1989;
210
93-99
-
27
Pao W J, Pilepich M V.
Postoperative radiotherapy in the treatment of extremity soft tissue sarcomas.
Int J Radiat Oncol Biol Phys.
1990;
19
907-911
-
28
Pisters P WT, Harrison L B, Leung D HY, Casper E S, Brennan M F.
Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma.
J Clin Oncol.
1996;
14
859-868
-
29
Pisters P WT, Harrison L B, Woodruff J M, Gaynor J J, Brennan M F.
A prospective randomized trial of adjuvant brachytherapy in the management of low-grade soft tissue sarcomas of the extremity and superficial trunk.
J Clin Oncol.
1994;
12
1150-1155
-
30
Pollock R E, Karnell L H, Menck H R, Winchester D P.
The National cancer data base report on soft tissue sarcoma.
Cancer.
1996;
78
2247-2257
-
31
Rosenberg S A, Kent H, Costa J, Webber B L, Path F F, Yong R, Chabner B, Baker A R, Brennan M F, Chretien P B, Cohen M H, deMoss E V, Sears H F, Seipp C, Simon R.
Prospective randomized evaluation of the role of limb-sparing surgery, radiation therapy, and adjuvant chemoimmunotherapy in the treatment of adult soft-tissue sarcomas.
Surgery.
1978;
84
62-68
-
32
Rosenberg S A, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, DeMoss E V, Seipp C, Sindelar W F, Sugarbaker P, Wesley R.
The treatment of soft-tissue sarcomas of the extremities.
Ann Surg.
1982;
196
305-314
-
33
Rydholm A, Gustafson P, Rööser B, Willen H, Akerman M, Herrlin K, Alvegard T.
Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma.
J Clin Oncol.
1991;
9
1757-1765
-
34
Sadoski C, Suit H D, Rosenberg A, Mankin H, Efird J.
Preoperative radiation, surgical margins, and local control of extremity sarcomas of soft tissues.
J Surg Oncol.
1993;
52
223-230
-
35
Schray M F, Gunderson L L, Sim F H, Pritchard D J, Shives T C, Yeakel P D.
Soft tissue sarcoma, integration of brachytherapy, resection, and external irradiation.
Cancer.
1990;
66
451-456
-
36
Sindelar W F, Kinsella T J, Chen P W, DeLaney T F, Tepper J E, Rosenberg S A.
Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial.
Arch Surg.
1993;
128
402-410
-
37
Slater J D, McNeese M D, Peters L J.
Radiation therapy for unresectable soft tissue sarcomas.
Int J Radiat Oncol Biol Phys.
1986;
12
1729-1734
-
38
Stinson S F, DeLaney T F, Greenberg J, Yang J C, Lampert M HH, J E, Venzon D, White D E, Rosenberg S A, Glatstein E J.
Acute and long-term effects of limb function of combined modality limb sparing therapy for extremity soft tissue sarcoma.
Int J Radiat Oncol Biol Phys.
1991;
21
1493-1499
-
39
Suit H.
Sarcoma of soft tissues: radiation sensitivity, treatment field margins, pathological margins, and dose-on Fein et al., IJROBP 32:969 - 976; 1995.
Int J Radiat Oncol Biol Phys.
1995;
32
1545-1546
-
40
Suit H D, Mankin H J, Wood W C, Gebhardt M C, Harmon D C, Rosenberg A, Tepper J E, Rosenthal D.
Treatment of the patient with stage M0 soft tissue sarcoma.
J Clin Oncol.
1988;
6
854-862
-
41
Suit H D, Mankin H J, Wood W C, Proppe K H.
Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma.
Cancer.
1985;
55
2659-2667
-
42
Suit H D, Spiro I.
Role of radiation in the management of adult patients with sarcoma of soft tissue.
Semin Surg Oncol.
1994;
10
347-356
-
43
Tanabe K K, Pollock R E, Ellis L M, Murphy A, Sherman N, Romsdahl M M.
Influence of surgical margins on outcome in patients with preoperative irradiated extremity soft tissue sarcomas.
Cancer.
1994;
73
1652-1659
-
44
Tepper J E, Suit J D.
Radiation therapy alone for sarcoma of soft tissue.
Cancer.
1985;
56
475-479
-
45
Tepper J E, Suit H D.
Radiation therapy of soft tissue sarcomas.
Cancer.
1985;
55
2273-2277
-
46
Wallner K E, Nori D, Burt M, Bains M, McCormack P.
Adjuvant brachytherapy for treatment of chest wall sarcomas.
J Thorac Cardiovasc Surg.
1991;
101
888-894
-
47
Willard W C, Hajdu S I, Casper E S, Brennan M F.
Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity.
Arch Surg.
1992;
215
269-275
-
48
Wolfson A H, Benedetto P W, Mnaymneh W, Moffat F L, Robinson D S, Boyer C, Raub W A, Duncan R C, Marcoe A M.
Does a radiation dose-response relation exist concerning survival of patients who have soft-tissue sarcomas of the extremities?.
Am J Clin Oncol.
1998;
21
270-274
-
49
Yang J C, Chang A E, Baker A R, Sindelar W F, Danforth D N, Topalian S L, DeLaney T, Glatstein E, Steinberg S M, Merino M J, Rosenberg S A.
Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity.
J Clin Oncol.
1998;
16
197-203
-
50
Zelefsky M J, Dattatreyudu N, Shiu M H, Brennan M F.
Limb salvage in soft tissue sarcomas involving neurovascular structures using combined surgical resection and brachytherapy.
Int J Radiat Oncol Biol Phys.
1990;
19
913-918
H.-J. Ochel
Klinik für Strahlentherapie
Medizinische Fakultät
Otto-von-Guericke-Universität
Leipziger Str. 44
39120 Magdeburg
Telefon: + 49-3916715791
Fax: + 49-3916715324
eMail: Hans-Joachim.Ochel@medizin.uni-magdeburg.de
