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Multimodale Therapiekonzepte bei Weichteilsarkomen

Multimodality therapy concepts for soft tissue sarcomas

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Zusammenfassung

Trotz der Tatsache, dass Weichteilsarkome mit einer Inzidenz von ca. 2–4 pro 100.000/Jahr eher zu den seltenen Tumoren zählen, erfordern sie in ganz besonderer Weise multimodale Therapiekonzepte. Basierend auf einer Referenzpathologie steht zunächst der Versuch einer kompletten chirurgischen Resektion im Vordergrund. Durch eine adjuvante Strahlentherapie kann bei den meisten Weichteilsarkomen nach erfolgter R0-Resektion die Lokalrezidivrate weiter gesenkt werden. Bei primär inoperablen oder nur unvollständig resezierbaren Tumoren ist eine neoadjuvante Chemotherapie unter Einschluss einer regionalen Tiefenhyperthermie zu diskutieren. Patienten mit metastasiertem Weichteilsarkom erhalten in palliativer Intention in der Regel eine anthrazyklinbasierte Chemotherapie. Prognostisch günstiger, auch im metastasierten Stadium, verlaufen gastrointestinale Stromatumoren, bei denen unter Einsatz der Tyrosinkinase-Inhibitoren Imatinib und Sunitinib lange Remissionszeiten induziert werden können.

Abstract

Despite the fact that soft tissue sarcomas are representing a rare tumor entity with a low incidence rate of about 2–4 per 100.000 per year, they highly require a multimodality therapeutic approach. Based on a reference pathology a complete surgical resection is the first treatment goal. After accomplished R0 resection the local relapse rate can be further decreased by an adjuvant radiotherapy. For primarily irresectable or only partially respectable tumors a neoadjuvant chemotherapy combined with regional hyperthermia should be considered. Patients with metastasized soft tissue sarcomas should receive an anthracyclin-based chemotherapy in a palliative intention. Prognostically more favorable are gastrointestinal stroma tumor, also in advanced stages with metastases, since the tyrosine kinase inhibitors imatinib and sunitinib can induce durable remissions.

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Authors and Affiliations

  1. Klinik I für Innere Medizin, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    C.-M. Wendtner

  2. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland

    S. Delank

  3. Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland

    H. Eich

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  1. C.-M. Wendtner
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  2. S. Delank
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  3. H. Eich
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Correspondence to C.-M. Wendtner.

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Wendtner, CM., Delank, S. & Eich, H. Multimodale Therapiekonzepte bei Weichteilsarkomen. Internist 51, 1388–1396 (2010). https://doi.org/10.1007/s00108-010-2672-8

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  • DOI: https://doi.org/10.1007/s00108-010-2672-8

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