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Systemische Therapie von Weichgewebssarkomen

Systemic therapy of soft tissue sarcomas

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Zusammenfassung

Goldstandard für die Behandlung von primär resektablen hochmalignen Weichgewebssarkomen ist die R0-Resektion in Kombination mit einer adjuvanten Radiotherapie. Sollte die Resektion nur mit einem mutilierenden oder ablativen Verfahren möglich sein, sind präoperative Therapieoptionen in das multimodale Therapiekonzept einzubeziehen. Bei metastasierten Weichteilsarkomen kommt die entscheidende Rolle der systemischen Therapie zu. Die wirksamsten Einzelsubstanzen sind die Anthrazykline Adriamycin und Epirubicin sowie Ifosfamid. Mit einer Kombinationstherapie werden meist höhere Ansprechraten erreicht, allerdings auf Kosten der Toxizität und ohne eindeutigen Nachweis einer Verlängerung des Gesamtüberlebens. Aktuelle Strategien zielen zunehmend auf die Entwicklung spezifischer Therapiekonzepte für klar definierte Subgruppen. Der Durchbruch zielgerichteter Therapien gelang mit der Einführung des Tyrosinkinaseinhibitors Imatinib bei der Behandlung gastrointestinaler Stromatumoren.

Abstract

The gold standard for the treatment of primary, resectable, high-grade soft tissue sarcomas is complete surgical removal followed by radiotherapy. In cases where preservation of function is not possible, preoperative treatment options should be considered. Systemic therapy is the treatment of choice for metastatic soft tissue sarcomas. The most active single agents include the anthracyclines doxorubicin and epirubicin, as well as ifosfamide. While combination chemotherapy yields higher response rates, this is at the cost of increased toxicity with no evidence of prolonged overall survival. Current treatment strategies focus on the development of specific treatments for well defined soft tissue sarcoma subtypes. The first and highly successful targeted therapy was seen with the introduction of imatinib in the treatment of gastrointestinal stromal tumors.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor Priv.-Doz. Dr. Peter Reichardt ist als Referent für die Firmen Novartis, Pfizer und PharmaMar tätig, ist Mitglied in Advisory Boards der Firmen Novartis, Pfizer und PharmaMar und erhält Studienunterstützung von der Firma Novartis. Bei den Autoren Dr. Daniel Pink und Dr. Janina Bertz-Lepel besteht kein Interessenkonflikt.

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  1. Klinik für Innere Medizin III mit Schwerpunkt Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad Saarow, Pieskower Str. 33, 15526, Bad Saarow, Deutschland

    D. Pink, J. Bertz-Lepel &  P. Reichardt

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  1. D. Pink
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  2. J. Bertz-Lepel
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  3. P. Reichardt
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Correspondence to P. Reichardt.

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Pink, D., Bertz-Lepel, J. & Reichardt, P. Systemische Therapie von Weichgewebssarkomen. Pathologe 32, 65–71 (2011). https://doi.org/10.1007/s00292-010-1397-8

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