Skip to main content
SpringerLink
Log in

Strahlentherapie bei Weichteilsarkomen

Radiotherapy of soft tissue sarcomas

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Da Weichteilsarkome in allen Körperregionen und Altersgruppen vorkommen, stellt ihre Therapie eine besondere interdisziplinäre Herausforderung dar. Die Strahlentherapie ist ein bei der Mehrzahl der Patienten wichtiger Bestandteil der Therapie.

Ziel

Die vorliegende Übersichtarbeit fasst die aktuell vorhandene Evidenz zu der Rolle der Strahlentherapie bei Weichteilsarkomen zusammen.

Material und Methoden

In der Pubmed-Datenbank wurden nach den Stichworten „sarcoma and radiotherapy“ unter den Kategorien „clinical trial, randomized controlled trial, meta-analysis“ und „review“ relevante Artikel bis Mai 2014 identifiziert, wobei die Suche bei „clinical trials“ auf die letzten 10 Jahre und bei den „Reviews“ auf die letzten 2 Jahre begrenzt wurde. Darüber hinaus wurden auch Zitate aus den 305 identifizierten Artikeln benutzt. Eine systematische Auswertung der Evidenzen aus den gefundenen Publikationen erfolgte nicht.

Ergebnisse

Weichteilsarkome gehören im Gegensatz zu früheren Einschätzungen zu den Tumorerkrankungen mit mittlerer Strahlenempfindlichkeit. Dementsprechend konnte in randomisierten Studien nachgewiesen werden, dass eine adjuvante Strahlentherapie nach Resektion des Tumors die lokale Rückfallrate hoch signifikant mindestens um den Faktor 3 reduziert. Im Falle einer perkutanen Strahlentherapie sind dafür Gesamtdosen von 60–66 Gy in konventioneller Fraktionierung (5 × 2 Gy pro Woche) notwendig. Der Nutzen der Strahlentherapie ist bei höher malignen Sarkomen (G2–3) und tief gelegenen Tumoren am größten. Die Nebenwirkungen der Strahlentherapie hängen sehr von der Lokalisation des Sarkoms ab. Trotz der Ausbildung von Fibrosen im höher dosierten Bereich (> 50 Gy) werden die funktionellen Ergebnisse durch Strahlentherapie nur wenig verschlechtert. Die präoperative Strahlentherapie hat sich als mindestens genauso effektiv erwiesen wie die postoperative, obwohl typischerweise nur 50 Gy in konventioneller Dosierung eingesetzt wurden. Insbesondere bei großen Weichteilsarkomen oder bei Lokalisation in Nachbarschaft zu strahlensensiblen Organen wie im Retroperitoneum sollte daher eine präoperative Strahlentherapie bevorzugt eingesetzt werden. In Abwesenheit belastbarer Daten spielt die moderne histologische Subtypisierung der Weichteilsarkome bei der Indikationsstellung zur Strahlentherapie bisher nur eine untergeordnete Rolle.

Diskussion

Die Strahlentherapie hat einen hohen Stellenwert in der Therapie der Weichteilsarkome. Der optimale Einsatz erfordert eine enge interdisziplinäre Abstimmung aller beteiligten Fachrichtungen.

Abstract

Background

As soft tissue sarcomas can arise in all regions of the body and at any age, the therapy represents a considerable interdisciplinary challenge. In the majority of patients radiotherapy is an important component of the treatment strategy.

Aim

The following review summarizes the currently available evidence regarding the role of radiotherapy in the treatment of soft tissue sarcomas.

Material and methods

A search in the PubMed database using the key words sarcoma and radiotherapy in the article types, clinical trial, randomized controlled trial, meta-analysis and “review was carried out to identify articles up to May 2014. The search for clinical trials was limited to the last 10 years and for reviews to the last 2 years. In addition, references included in the 305 identified manuscripts were also used. A systematic evaluation of the evidence based on the identified manuscripts was not performed.

Results

In contrast to previous suppositions soft tissue sarcomas belong to the moderately radiation sensitive tumor entities. Accordingly, in a number of randomized trials adjuvant radiotherapy after surgical resection radiotherapy was shown to significantly decrease the local recurrence rate by at least a factor of 3. In cases of percutaneous radiotherapy, total doses of 60–66 Gy in conventional fractionation (5 × 2 Gy per week) were required for this effect. The benefits of radiotherapy are greater in the more malignant sarcomas (G2–3) and deep seated tumors. The side effects of radiotherapy depend greatly on the location of the sarcoma. In spite of the formation of fibrosis in high-dose areas (> 50 Gy) functional results are generally only moderately impaired by radiotherapy. Preoperative radiotherapy has been shown to be as least as effective as postoperative radiotherapy, although typically only 50 Gy in conventional fractionation was applied. Especially in large soft tissue sarcomas or in locations close to radiation-sensitive organs, such as the retroperitoneum, preoperative radiotherapy should be preferentially considered. In the absence of validated data modern histological subtyping of soft tissue sarcomas has so far little influence on the indications for radiotherapy.

Discussion

Radiotherapy plays an important role in the management of soft tissue sarcomas. The optimal usage requires a close interdisciplinary coordination of all disciplines involved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2

Literatur

  1. Weichselbaum RR, Beckett MA, Vijayakumar S et al (1990) Radiobiological characterization of head and neck and sarcoma cells derived from patients prior to radiotherapy. Int J Radiat Oncol Biol Phys 19(2):313–319

    Article  PubMed  CAS  Google Scholar 

  2. Budach W, Paulsen F, Welz S et al (2002) Mitomycin C in combination with radiotherapy as a potent inhibitor of tumour cell repopulation in a human squamous cell carcinoma. Br J Cancer 86(3):470–476

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  3. Budach W, Budach V, Dinges S et al (1997) Correlation between primary chemo- and radiation sensitivity in a panel of highly malignant human soft tissue sarcoma xenografts. Radiother Oncol 42(2):181–187

    Article  PubMed  CAS  Google Scholar 

  4. Willett CG, Schiller AL, Suit HD et al (1987) The histologic response of soft tissue sarcoma to radiation therapy. Cancer 60:1500–1504

    Article  PubMed  CAS  Google Scholar 

  5. MacDermed DM, Miller LL, Peabody TD et al (2010) Primary tumor necrosis predicts distant control in locally advanced soft-tissue sarcomas after preoperative concurrent chemoradiotherapy. Int J Radiat Oncol Biol Phys 76(4):1147–1153

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pisters PW, Patel SR, Prieto VG et al (2004) Phase I trial of preoperative doxorubicin-based concurrent chemoradiation and surgical resection for localized extremity and body wall soft tissue sarcomas. J Clin Oncol 22(16):3375–3380

    Article  PubMed  CAS  Google Scholar 

  7. Hew L, Kandel R, Davis A et al (1994) Histological necrosis in soft tissue sarcoma following preoperative irradiation. J Surg Oncol 57(2):111–114

    Article  PubMed  CAS  Google Scholar 

  8. Abbatucci JS, Boulier N, Ranieri J de et al (1986) Local control and survival in soft tissue sarcomas of the limbs, trunk walls and head and neck: a study of 113 cases. Int J Radiat Oncol Biol Phys 12:579–586

    Article  PubMed  CAS  Google Scholar 

  9. Kepka L, DeLaney TF, Suit HD, Goldberg SI (2005) Results of radiation therapy for unresected soft-tissue sarcomas. Int J Radiat Oncol Biol Phys 63(3):852–859

    Article  PubMed  Google Scholar 

  10. Eckert F, Matuschek C, Mueller AC et al (2010) Definitive radiotherapy and single-agent radiosensitizing ifosfamide in patients with localized, irresectable soft tissue sarcoma: a retrospective analysis. Radiat Oncol 5:55

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rosenberg SA, Tepper J, Glatstein E et al (1982) The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 196(3):305–315

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Yang JC, Chang AE, Baker AR et al (1998) Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 16(1):197–203

    PubMed  CAS  Google Scholar 

  13. Jebsen NL, Trovik CS, Bauer HC et al (2008) Radiotherapy to improve local control regardless of surgical margin and malignancy grade in extremity and trunk wall soft tissue sarcoma: a Scandinavian sarcoma group study. Int J Radiat Oncol Biol Phys 71(4):1196–1203

    Article  PubMed  Google Scholar 

  14. Pisters PW, Harrison LB, Leung DH et al (1996) Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 14(3):859–868

    PubMed  CAS  Google Scholar 

  15. Pisters PW, Leung DH, Woodruff J et al (1996) Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 14(5):1679–1689

    PubMed  CAS  Google Scholar 

  16. Delaney TF, Kepka L, Goldberg SI et al (2007) Radiation therapy for control of soft-tissue sarcomas resected with positive margins. Int J Radiat Oncol Biol Phys 67(5):1460–1469

    Article  PubMed  Google Scholar 

  17. Sampath S, Schultheiss TE, Hitchcock YJ et al (2011) Preoperative versus postoperative radiotherapy in soft-tissue sarcoma: multi-institutional analysis of 821 patients. Int J Radiat Oncol Biol Phys 81(2):498–505

    Article  PubMed  Google Scholar 

  18. Al-Absi E, Farrokhyar F, Sharma R et al (2010) A systematic review and meta-analysis of oncologic outcomes of pre- versus postoperative radiation in localized resectable soft-tissue sarcoma. Ann Surg Oncol 17(5):1367–1374

    Article  PubMed  Google Scholar 

  19. O’Sullivan B, Davis AM, Turcotte R et al (2002) Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 359(9325):2235–2241

    Article  Google Scholar 

  20. Sadoski C, Suit HD, Rosenberg A et al (1993) Preoperative radiation, surgical margins, and local control of extremity sarcomas of soft tissues. J Surg Oncol 52(4):223–230

    Article  PubMed  CAS  Google Scholar 

  21. Dagan R, Indelicato DJ, McGee L et al (2012) The significance of a marginal excision after preoperative radiation therapy for soft tissue sarcoma of the extremity. Cancer 118(12):3199–3207

    Article  PubMed  Google Scholar 

  22. Al Yami A, Griffin AM, Ferguson PC et al (2010) Positive surgical margins in soft tissue sarcoma treated with preoperative radiation: is a postoperative boost necessary? Int J Radiat Oncol Biol Phys 77(4):1191–1197

    Article  Google Scholar 

  23. Jones JJ, Catton CN, O’Sullivan B et al (2002) Initial results of a trial of preoperative external-beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma. Ann Surg Oncol 9(4):346–354

    Article  PubMed  Google Scholar 

  24. Sampath S, Hitchcock YJ, Shrieve DC et al (2010) Radiotherapy and extent of surgical resection in retroperitoneal soft-tissue sarcoma: multi-institutional analysis of 261 patients. J Surg Oncol 101(5):345–350

    PubMed  Google Scholar 

  25. Sindelar WF, Kinsella TJ, Chen PW et al (1993) Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg 128(4):402–410

    Article  PubMed  CAS  Google Scholar 

  26. Oertel S, Treiber M, Zahlten-Hinguranage A et al (2006) Intraoperative electron boost radiation followed by moderate doses of external beam radiotherapy in limb-sparing treatment of patients with extremity soft-tissue sarcoma. Int J Radiat Oncol Biol Phys 64(5):1416–1423

    Article  PubMed  Google Scholar 

  27. Pisters PW, O’Sullivan B (2002) Retroperitoneal sarcomas: combined modality treatment approaches. Curr Opin Oncol 14(4):400–405

    Article  PubMed  Google Scholar 

  28. Petersen IA, Haddock MG, Donohue JH et al (2002) Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys 52(2):469–475

    Article  PubMed  Google Scholar 

  29. Ballo MT, Zagars GK, Pollock RE et al (2007) Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment. Int J Radiat Oncol Biol Phys 67(1):158–163

    Article  PubMed  Google Scholar 

  30. Look Hong NJ, Hornicek FJ, Harmon DC et al (2013) Neoadjuvant chemoradiotherapy for patients with high-risk extremity and truncal sarcomas: a 10-year single institution retrospective study. Eur J Cancer 49(4):875–883

    Article  Google Scholar 

  31. Kraybill WG, Harris J, Spiro IJ et al (2010) Long-term results of a phase 2 study of neoadjuvant chemotherapy and radiotherapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. Cancer 116(19):4613–4621

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  32. Aguiar Junior S, Ferreira Fde O, Rossi BM et al (2009) Neoadjuvant chemoradiation therapy for soft tissue sarcomas of the extremities. Clinics (Sao Paulo) 64(11):1059–1064

  33. Temple CL, Ross DC, Magi E et al (2007) Preoperative chemoradiation and flap reconstruction provide high local control and low wound complication rates for patients undergoing limb salvage surgery for upper extremity tumors. J Surg Oncol 95(2):135–141

    Article  PubMed  CAS  Google Scholar 

  34. Hegazy MA, Kotb SZ, Sakr H et al (2007) Preoperative isolated limb infusion of Doxorubicin and external irradiation for limb-threatening soft tissue sarcomas. Ann Surg Oncol 14(2):568–576

    Article  PubMed  Google Scholar 

  35. Issels RD, Lindner LH, Verweij J et al (2010) Neo-adjuvant chemotherapy alone or with regional hyperthermia for localized high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol 11(6):561–570

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  36. Bonvalot S, Baere T de, Mendiboure J et al (2012) Hyperthermic pelvic perfusion with tumor necrosis factor-α for locally advanced cancers: encouraging results of a phase II study. Ann Surg 255(2):281–286

    Article  PubMed  Google Scholar 

  37. Wang D, Bosch W, Roberge D et al (2011) RTOG sarcoma radiation oncologists reach consensus on gross tumor volume and clinical target volume on computed tomographic images for preoperative radiotherapy of primary soft tissue sarcoma of extremity in Radiation Therapy Oncology Group studies. Int J Radiat Oncol Biol Phys 81(4):e525–e528

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Budach und C. Matuschek geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen und Tieren.

Author information

Authors and Affiliations

  1. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    W. Budach & C. Matuschek

Authors
  1. W. Budach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Matuschek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Budach.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Budach, W., Matuschek, C. Strahlentherapie bei Weichteilsarkomen. Onkologe 20, 1113–1120 (2014). https://doi.org/10.1007/s00761-014-2713-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-014-2713-3

Schlüsselwörter

Keywords

Search

Navigation