Skip to main content
SpringerLink
Log in

Multimodales Management bei Weichteilsarkomen des Stammes und der Extremitäten

Multimodal management in soft tissue sarcoma of the trunk and extremities

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Weichteilsarkome (WTS) stellen eine seltene, äußerst heterogene Gruppe maligner mesodermaler Tumoren dar. Mit einer Inzidenz von 1 bis 5/100.000/Jahr machen sie nur ca. 1 % aller Malignome des Menschen aus. WTS entstehen bevorzugt an der unteren Extremität und am Stamm. Es werden über 100 histopathologische Subentitäten unterschieden. Das Langzeitüberleben variiert in Abhängigkeit von Lokalisation und Histologie erheblich. Während durch die Einführung multimodaler Therapiekonzepte sowohl die Lokalrezidivraten als auch das Gesamtüberleben der Extremitätensarkome signifikant verbessert werden konnten, ist bei den Sarkomen des Körperstammes nur geringer Fortschritt im Patientenmanagement zu verzeichnen. Der vorliegende Artikel soll einen Überblick über präoperative Diagnostikverfahren, Pathologie und neoadjuvante als auch adjuvante Therapiemodi bei Weichteilsarkomen geben.

Abstract

Soft tissue sarcoma (STS) is a rare, extremely heterogeneous group of malignant tumors of mesodermal origin. With an incidence of 1–5 per 100,000/year they account for only 1 % of all human malignancies. The STSs occur predominantly in the lower extremities and the trunk. To date 100 different histopathological subentities can be defined. The prognosis varies substantially depending on the localization and histology. Whereas local recurrence rates and overall survival of sarcomas of the extremities have benefited from the introduction of multimodal therapies, only marginal progress has been made in the management of trunk STSs. This manuscript gives an overview of preoperative diagnostics, pathology and neoadjuvant as well as adjuvant therapeutic options for soft tissue sarcoma.

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.

Institutional subscriptions

Abb. 1

Literatur

  1. 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 17:1367–1374

    Article  PubMed  Google Scholar 

  2. Bonvalot S, Cavalcanti A, Le Péchoux C et al (2005) Randomized trial of cytoreduction followed by intraperitoneal chemotherapy versus cytoreduction alone in patients with peritoneal sarcomatosis. Eur J Surg Oncol 31:917–923

    Article  CAS  PubMed  Google Scholar 

  3. Brennan MF, Casper ES, Harrison LD et al (1991) The role of multimodality therapy in soft tissue sarcoma. Ann Surg 214:328–336

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Choi AH, Barnholtz-Sloan JS, Kim JA (2012) Effect of radiation therapy on survival in surgically resected retroperitoneal sarcoma: a propensity score adjusted SEER analysis. Ann Oncol 23:2449–2457

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Drapé JL (2013) Advances in magnetic resonance imaging of musculoskeletal tumours. Orthop Traumatol Surg Res 99:115–123

    Article  Google Scholar 

  6. Gortzak E, Azzarelli A, Buesa J et al (2001) A randomised phase II study on neo-adjuvant chemotherapy for ‚high-risk‘ adult soft-tissue sarcoma. Eur J Cancer 37:1096–1103

    Article  CAS  PubMed  Google Scholar 

  7. Issels RD, Lindner LH, Verweij J et al (2010) Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol 11:561–170

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Lahat G, Tuvin D, Wei C et al (2008) New perspectives for staging and prognosis in soft tissue sarcoma. Ann Surg Oncol 15:2739–2748

    Article  CAS  PubMed  Google Scholar 

  9. Le Péchoux C, Musat E, Baey C et al (2013) Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma? Ann Oncol 24:832–837

    Article  Google Scholar 

  10. Meric F, Hess KR, Varma DG et al (2002) Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas. Cancer 95:1120–1126

    Article  PubMed  Google Scholar 

  11. O’Sullivan B, Gullane P, Irish J et al (2003) Preoperative radiotherapy for adult head and neck soft tissue sarcoma: assessmant of wound complication rates and cancer outcome in a prospective series. World J Surg 27:875–883

    Article  Google Scholar 

  12. O’Sullivan B, Griffin AM, Dickie CI et al (2013) Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma. Cancer 119:1878–1884

    Article  Google Scholar 

  13. Rehders A, Stoecklein NH, Poremba C et al (2009) Reexcision of soft tissue sarcoma: sufficient local control but increased rate of metastasis. World J Surg 33:2599–2605

    Article  CAS  PubMed  Google Scholar 

  14. Sarcoma Meta-analysis Collaboration (SMAC) (2000) Adjuvant chemotherapy for localised resectable soft tissue sarcoma in adults. Cochrane Database Syst Rev 4:CD001419

    Google Scholar 

  15. Schray MF, Gunderson LL, Sim FH et al (1990) Soft tissue sarcoma. Integration of brachytherapy, resection and external irradiation. Cancer 66:451–456

    Article  CAS  PubMed  Google Scholar 

  16. Siegel R, DeSantis C, Virgo K et al (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62:220–241

    Article  PubMed  Google Scholar 

  17. Stoeckle E, Coindre JM, Bonvalot S et al (2001) Prognostic factorsin retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 92:359–368

    Article  CAS  PubMed  Google Scholar 

  18. Wibmer C, Leithner A, Zielonke N et al (2010) Increasing incidence rates of soft tissue sarcomas? A population-based epidemiologogic study and literature review. Ann Oncol 21:1106–1111

    Article  CAS  PubMed  Google Scholar 

  19. Woll PJ, Reichardt P, Le Cesne A et al (2012) Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol 13:1045–1054

    Article  CAS  PubMed  Google Scholar 

  20. NCCN Clinical Practice Guidelines in Oncology™. V.2.2007 www.nccn.org

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. M.P.H. Ghadimi, A. Rehders und W. Trudo Knoefel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Chirurgische Klinik (A), Allgemein-, Thorax-, Viszeral- und Kinderchirurgie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M.P.H. Ghadimi, A. Rehders &  W.T. Knoefel

Authors
  1. M.P.H. Ghadimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Rehders
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W.T. Knoefel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W.T. Knoefel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghadimi, M., Rehders, A. & Knoefel, W. Multimodales Management bei Weichteilsarkomen des Stammes und der Extremitäten. Chirurg 85, 378–382 (2014). https://doi.org/10.1007/s00104-013-2690-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-013-2690-x

Schlüsselwörter

Keywords

Search

Navigation