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Multimodale Therapie bei Weichteilsarkomen des Erwachsenen

Multidisciplinary treatment for adult soft tissue sarcoma

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Zusammenfassung

Die aktuelle lokale Therapie von Weichteilsarkomen nimmt im Vergleich zu früher mehr Rücksicht auf Organ- und Funktionserhalt. Amputationen und ähnlich mutilierende Eingriffe am Körperstamm werden seltener durchgeführt. Dafür hat die multidisziplinäre Therapie, insbesondere die adjuvante Strahlentherapie an Bedeutung gewonnen. Sie führt zu einer signifikanten Verbesserung der lokalen Tumorkontrolle bei Hochrisikosarkomen und bei knappen Resektionsgrenzen. Das Gesamtüberleben hat sie leider bisher nicht nennenswert verbessern können. Auch perioperative Chemotherapien haben bisher global nicht zu einer Verbesserung der Gesamtprognose beigetragen. Fortschritte zeichnen sich jedoch dort ab, wo ein besseres Verständnis über die Pathogenese und das molekulare Profil von Sarkomsubtypen besteht und damit spezifische medikamentöse Therapien zum Einsatz gebracht werden können. Ein Beispiel ist die Behandlung von fortgeschrittenen gastrointestinalen Stromatumoren mittels Imatinib, einem Kinase-Inhibitor am c-kit-Rezeptor. Aktuell ist das wichtigste Instrument zur Verbesserung der Prognose bei Weichteilsarkomen die frühzeitige Überweisung des Patienten an ein erfahrenes Referenzzentrum, wo bereits die Diagnostik und im Weiteren die Therapiesteuerung im multidisziplinären Kontext und unter Berücksichtigung der aktuellen Datenlage, der Leitlinien und laufender Studien erfolgen kann.

Abstract

The current standard in local treatment of soft tissue sarcomas has shifted from amputation and similar mutilating resections to more organ- and function-preserving surgery. This was possible through multidisciplinary treatment approaches, particularly those including adjuvant radiation therapy. Adjuvant radiation showed significant improvement in local tumour control after resection with tight margins and in high-risk sarcomas. Unfortunately adjuvant radiation failed to improve overall survival. Perioperative chemotherapies also have not contributed to improvement in the overall prognosis worldwide. Progress may occur when the pathogenesis and molecular profile of specific sarcoma subtypes are better understood, allowing more effective new drugs. One example is the treatment of advanced gastrointestinal stromal tumour with imatinib, a small molecular kinase inhibitor of the c-kit receptor. Presently the most effective measure to improve the prognosis with soft tissue sarcomas is early patient referral to expert centres, where diagnostic workup and therapy decisions are made on a multidisciplinary basis and updated according to the newest guidelines and study results.

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  1. Nationales Centrum für Tumorerkrankungen Medizinische Onkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Deutschland

    F. Lordick

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Lordick, F. Multimodale Therapie bei Weichteilsarkomen des Erwachsenen. Chirurg 80, 209–215 (2009). https://doi.org/10.1007/s00104-008-1597-4

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