Advertisement

Der Onkologe

, Volume 21, Issue 12, pp 1147–1161 | Cite as

Weichtteiltumoren

Allgemein-klinische Aspekte – chirurgische und medikamentöse Therapie
  • E. Schalk
  • B. Garlipp
  • C.J. Bruns
  • T. FischerEmail author
Leitthema
  • 334 Downloads

Zusammenfassung

Hintergrund

Maligne Weichteiltumoren sind sehr seltene bösartige Neubildungen mesenchymalen Ursprungs. Dies stellt nicht nur eine diagnostische, sondern auch eine therapeutische Herausforderung dar.

Ziel

Ziel ist die Darstellung allgemein-klinischer Aspekte sowie aktueller Strategien zur Diagnostik und Therapie von malignen Weichteiltumoren.

Material und Methoden

Der Beitrag ist ein Übersichtsartikel, der auf der Auswertung aktueller Literatur sowie Erfahrungen der Autoren basiert.

Ergebnisse

Maligne Weichteiltumoren sind am häufigsten in den Extremitäten lokalisiert, kommen aber auch abdominell und reptroperitoneal vor. Tumorgröße, hoher Malignitätsgrad und tiefe Lokalisation sind als Prognosefaktoren etabliert. Magnetresonanz- und Computertomographie sind die diagnostischen Methoden der Wahl. Das chirurgische Ziel ist die vollständige chirurgische Entfernung des Primärtumors. Eine adjuvante Chemotherapie und/oder Radiatio sollten bei Hochrisikopatienten diskutiert werden. Als palliative Therapieoptionen stehen Adriamycin, Ifosfamid sowie neuere Wirkstoffe wie Trabectedin und Pazopanib zur Verfügung.

Schlussfolgerungen

Die Therapie maligner Weichteiltumoren setzt ein interdisziplinäres Vorgehen voraus. Die Patienten sollten in einem spezialisierten Zentrum vorgestellt werden. Die Therapieziele werden in einer interdisziplinären Tumorkonferenz zwischen operativen Disziplinen, Strahlentherapie, Radiologie und internistischer Onkologie abgestimmt.

Schlüsselwörter

Weichteilsarkome Chirurgie Adriamycin Ifosfamid Trabectedin 

Soft tissue tumors

General clinical—surgical and pharmacological therapy

Abstract

Background

Malignant soft tissue tumors are very rare malignancies of mesenchymal origin and are a diagnostic as well as a therapeutic challenge.

Objective

Discussion of general clinical aspects and current strategies for diagnostics and therapy of malignant soft tissue tumors.

Material and methods

Review article based on the current literature and authors’ experience.

Results

Malignant soft tissue tumors are most frequently localized in the extremities but also occur in the abdomen and retroperitoneum. Tumor size, high histopathological grade and deep tumor localization are well established prognostic factors. Magnetic resonance imaging and computed tomography are the diagnostic methods of choice. At initial diagnosis, the surgical goal is complete resection of the primary tumor. Adjuvant chemotherapy and/or radiotherapy need to be discussed in cases of a high-risk situation. Palliative therapy options are doxorubicin, ifosfamide as well as newer agents, such as trebectedin and pazopanib.

Conclusion

For the therapy of soft tissue sarcomas an interdisciplinary approach is essential. Patient care should be referred to a specialized medical center. The therapeutic goals need to be discussed in an interdisciplinary tumor board between the fields of surgery, radiotherapy, radiology and medical oncology.

Keywords

Soft tissue sarcoma Surgery Doxorubicin Ifosfamide Trabectedin 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. E. Schalk, B. Garlipp, C.J. Bruns und T. Fischer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Fletcher CDM (2013) WHO classification of tumours of soft tissue and bone. IARC Press, Lyon. ISBN 9283224345Google Scholar
  2. 2.
    Cerny T, Issels RD, Budach V et al (2006) Weichteilsarkom. In: Schmoll HJ, Höffken K, Possinger K (Hrsg) Kompendium Internistische Onkologie. Srpinger, Berlin, S 5192–5250Google Scholar
  3. 3.
    Schlag PM, Hartmann JT, Budach V (2011) Weichgewebetumoren. Interdisziplinäres Management. Springer-Verlag, Berlin. ISBN 978-3-642-04938-5Google Scholar
  4. 4.
    Iwasaki H, Nabeshima K, Nishio J et al (2009) Pathology of soft-tissue tumors: daily diagnosis, molecular cytogenetics and experimental approach. Pathol Int 59:501–521CrossRefPubMedGoogle Scholar
  5. 5.
    Lindner LH, Hiddemann W (2013) Hämatoonkologische Krankheitsbilder. Internist 54:1197–1204CrossRefPubMedGoogle Scholar
  6. 6.
    Hartmann JT (2014) Medikamentöse Tumortherapie bei Weichteilsarkomen. Onkologe 20:1121–1128CrossRefGoogle Scholar
  7. 7.
    Blauvelt A (1999) The role of human herpesvirus 8 in the pathogenesis of Kaposi’s sarcoma. Adv Dermatol 14:167–206 (discussion 207)PubMedGoogle Scholar
  8. 8.
    Weiss RA, Whitby D, Talbot S et al (1998) Human herpesvirus type 8 and Kaposi’s sarcoma. J Natl Cancer Inst Monogr 23:51–54CrossRefPubMedGoogle Scholar
  9. 9.
    Karlsson P, Holmberg E, Samuelsson A et al (1998) Soft tissue sarcoma after treatment for breast cancer – a Swedish population-based study. Eur J Cancer 34:2068–2075CrossRefPubMedGoogle Scholar
  10. 10.
    Gustafson P (1994) Soft tissue sarcoma. Epidemiology and prognosis in 508 patients. Acta Orthop Scand Suppl 259:1–31PubMedGoogle Scholar
  11. 11.
    Johnson CJ, Pynsent PB, Grimer RJ (2001) Clinical features of soft tissue sarcomas. Ann R Coll Surg Engl 83:203–205PubMedCentralPubMedGoogle Scholar
  12. 12.
    Wittekind C, Meyer HJ (2010) TNM. Klassifikation maligner Tumoren. Wiley-Blackwell, Somerset. ISBN 978-3-527-32759-1Google Scholar
  13. 13.
    Weitz J, Antonescu CR, Brennan MF (2003) Localized extremity soft tissue sarcoma: improved knowledge with unchanged survival over time. J Clin Oncol 21:2719–2725CrossRefPubMedGoogle Scholar
  14. 14.
    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 14:1679–1689PubMedGoogle Scholar
  15. 15.
    Italiano A, Mathoulin-Pelissier S, Le Cesne A et al (2011) Trends in survival for patients with metastatic soft-tissue sarcoma. Cancer 117:1049–1054CrossRefPubMedGoogle Scholar
  16. 16.
    Parsons AM, Detterbeck FC, Parker LA (2004) Accuracy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still necessary? Ann Thorac Surg 78:1910–1916 (discussion 1916–1918)CrossRefPubMedGoogle Scholar
  17. 17.
    Rubin GD, Lyo JK, Paik DS et al (2005) Pulmonary nodules on multi-detector row CT scans: performance comparison of radiologists and computer-aided detection. Radiology 234:274–283CrossRefPubMedGoogle Scholar
  18. 18.
    Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMedGoogle Scholar
  19. 19.
    The ESMO/European Sarcoma Network Working Group (2014) Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii102–iii112CrossRefGoogle Scholar
  20. 20.
    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology – Soft tissue sarcomas. http://www.nccn.org/professionals/physician_gls/pdf/sarcoma.pdf. Zugegriffen: 14. Feb. 2015Google Scholar
  21. 21.
    Gronchi A, Lo Vullo S, Colombo C et al (2010) Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival. Ann Surg 251:506–511CrossRefPubMedGoogle Scholar
  22. 22.
    Bonvalot S, Rivoire M, Castaing M et al (2009) Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol 27:31–37CrossRefPubMedGoogle Scholar
  23. 23.
    Gronchi A, Lo Vullo S, Fiore M et al (2009) Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol 27:24–30CrossRefPubMedGoogle Scholar
  24. 24.
    Haglund KE, Raut CP, Nascimento AF et al (2012) Recurrence patterns and survival for patients with intermediate- and high-grade myxofibrosarcoma. Int J Radiat Oncol Biol Phys 82:361–367CrossRefPubMedGoogle Scholar
  25. 25.
    Sanfilippo R, Miceli R, Grosso F et al (2011) Myxofibrosarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol 18:720–725CrossRefPubMedGoogle Scholar
  26. 26.
    Stojadinovic A, Yeh A, Brennan MF (2002) Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes. J Am Coll Surg 194:436–447CrossRefPubMedGoogle Scholar
  27. 27.
    Hassan I, Park SZ, Donohue JH et al (2004) Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg 239:244–250PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Stoeckle E, Coindre JM, Bonvalot S et al (2001) Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 92:359–368CrossRefPubMedGoogle Scholar
  29. 29.
    Ghadimi MP, Al-Zaid T, Madewell J et al (2011) Diagnosis, management, and outcome of patients with dedifferentiated liposarcoma systemic metastasis. Ann Surg Oncol 18:3762–3770CrossRefPubMedGoogle Scholar
  30. 30.
    Mussi C, Colombo P, Bertuzzi A et al (2011) Retroperitoneal sarcoma: is it time to change the surgical policy? Ann Surg Oncol 18:2136–2142CrossRefPubMedGoogle Scholar
  31. 31.
    Trans-Atlantic RPS Working Group (2015) Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol 22:256–263CrossRefGoogle Scholar
  32. 32.
    Gronchi A, Miceli R, Colombo C et al (2012) Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas. Ann Oncol 23:1067–1073CrossRefPubMedGoogle Scholar
  33. 33.
    Gronchi A, Miceli R, Allard MA et al (2014) Personalizing the approach to retroperitoneal soft tissue sarcoma: histology-specific patterns of failure and postrelapse outcome after primary extended resection. Ann Surg Oncol. doi:10.1245/s10434-014-4130-7Google Scholar
  34. 34.
    Bonvalot S, Miceli R, Berselli M et al (2010) Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control. Ann Surg Oncol 17:1507–1514CrossRefPubMedGoogle Scholar
  35. 35.
    Santos CER, Correia MM, Thuler LCS et al (2010) Compartment surgery in treatment strategies for retroperitoneal sarcomas: a single-center experience. World J Surg 34:2773–2781CrossRefPubMedGoogle Scholar
  36. 36.
    Pasquali S, Vohra R, Tsimopoulou I et al (2015) Outcomes following extended surgery for retroperitoneal sarcomas: results from a UK referral centre. Ann Surg Oncol. doi:10.1245/s10434-015-4380-zGoogle Scholar
  37. 37.
    Tseng WW, Madewell JE, Wei W et al (2014) Locoregional disease patterns in well-differentiated and dedifferentiated retroperitoneal liposarcoma: implications for the extent of resection? Ann Surg Oncol 21:2136–2143CrossRefPubMedGoogle Scholar
  38. 38.
    Surgery With or Without Radiation Therapy in Treating Patients With Previously Untreated Nonmetastatic Retroperitoneal Soft Tissue Sarcoma (STRASS). https://clinicaltrials.gov/ct2/show/NCT01344018. Zugegriffen: 15. Feb. 2015Google Scholar
  39. 39.
    Gronchi A, Casali PG, Fiore M et al (2004) Retroperitoneal soft tissue sarcomas: patterns of recurrence in 167 patients treated at a single institution. Cancer 100:2448–2455CrossRefPubMedGoogle Scholar
  40. 40.
    Neuhaus SJ, Barry P, Clark MA et al (2005) Surgical management of primary and recurrent retroperitoneal liposarcoma. Br J Surg 92:246–252CrossRefPubMedGoogle Scholar
  41. 41.
    Geel AN van, Pastorino U, Jauch KW et al (1996) Surgical treatment of lung metastases: the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group study of 255 patients. Cancer 77:675–682CrossRefPubMedGoogle Scholar
  42. 42.
    Billingsley KG, Burt ME, Jara E et al (1999) Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. Ann Surg 229:602–610 (discussion 610–612)PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Blackmon SH, Shah N, Roth JA et al (2009) Resection of pulmonary and extrapulmonary sarcomatous metastases is associated with long-term survival. Ann Thorac Surg 88:877–884 (discussion 884–885)CrossRefPubMedGoogle Scholar
  44. 44.
    Singer S, Demetri GD, Baldini EH et al (2000) Management of soft-tissue sarcomas: an overview and update. Lancet Oncol 1:75–85CrossRefPubMedGoogle Scholar
  45. 45.
    Sarcoma Meta-Analysis Collaboration (1997) Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Lancet 350:1647–1654CrossRefGoogle Scholar
  46. 46.
    Pervaiz N, Colterjohn N, Farrokhyar F et al (2008) A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 113:573–581CrossRefPubMedGoogle Scholar
  47. 47.
    O’Connor JM, Chacón M, Petracci FE, Chacón RD (2008) Adjuvant chemotherapy in soft tissue sarcoma (STS): a meta-analysis of published data. J Clin Oncol 26:10526 (abstract)Google Scholar
  48. 48.
    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 13:1045–1054CrossRefPubMedGoogle Scholar
  49. 49.
    Verma S, Younus J, Stys-Norman D et al (2008) Meta-analysis of ifosfamide-based combination chemotherapy in advanced soft tissue sarcoma. Cancer Treat Rev 34:339–347CrossRefPubMedGoogle Scholar
  50. 50.
    Glabbeke M van, Verweij J, Judson I et al (2002) Progression-free rate as the principal end-point for phase II trials in soft-tissue sarcomas. Eur J Cancer 38:543–549CrossRefPubMedGoogle Scholar
  51. 51.
    Demetri GD, Chawla SP, Mehren M von et al (2009) Efficacy and safety of trabectedin in patients with advanced or metastatic liposarcoma or leiomyosarcoma after failure of prior anthracyclines and ifosfamide: results of a randomized phase II study of two different schedules. J Clin Oncol 27:4188–4196CrossRefPubMedGoogle Scholar
  52. 52.
    Graaf WTA van der, Blay J, Chawla SP et al (2012) Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 379:1879–1886CrossRefPubMedGoogle Scholar
  53. 53.
    Verma S, Younus J, Haynes AE et al (2008) Dose-intensive chemotherapy with growth factor or autologous bone marrow or stem-cell transplant support in first-line treatment of advanced or metastatic adult soft tissue sarcoma: a clinical practice guideline. Curr Oncol 15:80–84PubMedCentralCrossRefPubMedGoogle Scholar
  54. 54.
    Schütte J, Hartmann JT, Reichardt P (2011) Onkopedia: Weichteilsarkome. https://www.dgho-onkopedia.de/de/onkopedia/leitlinien/weichteilsarkomeGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Klinik für Hämatologie und Onkologie, Zentrum für Innere MedizinUniversitätsklinikum, Otto-von-Guericke-Universität MagdeburgMagdeburgDeutschland
  2. 2.Klinik für Allgemein-, Viszeral- und GefäßchirurgieUniversitätsklinikum, Otto-von-Guericke-Universität MagdeburgMagdeburgDeutschland

Personalised recommendations