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Multimodale Therapiekonzepte von Weichteilsarkomen bei kurativer und palliativer Therapieabsicht

Curative and palliative multimodal treatment concepts for soft tissue sarcomas

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Für Patienten mit lokal fortgeschrittenen High-Grade-Weichteilsarkomen besteht sowohl ein Risiko für das Auftreten eines Lokalrezidivs als auch für das Auftreten von Fernmetastasen bei alleiniger Tumorresektion.

Ergebnisse

Für die neoadjuvante Chemotherapie liegen 2 Phase-III-Studien vor. Die ISG1001-Studie zeigt, dass eine anthrazyklinbasierte Chemotherapie einer histologiespezifischen Chemotherapie überlegen ist. Die EORTC-62961/ESHO-RHT95-Studie zeigt, dass die Effektivität einer anthrazyklinbasierten Chemotherapie durch die Hinzunahme der regionalen Tiefenhyperthermie gesteigert werden kann. Nachdem beiden Studien ohne Kontrollarm mit alleiniger Lokaltherapie durchgeführt wurden, sind die Ergebnisse der retrospektiven Analyse der adjuvanten EORTC-62931-Studie von besonderer Bedeutung. Für Patienten mit nach Sarculator schlechter Prognose war adjuvante anthrazyklinbasierte Chemotherapie gegenüber einer alleinigen Lokaltherapie mit einem signifikanten Überlebensvorteil verbunden. Während der Stellenwert einer Strahlentherapie für High-Grade-Extremitätensarkome unstrittig ist, konnte der Nutzen einer präoperativen Strahlentherapie für retroperitoneale Sarkome bislang nicht allgemein gezeigt werden.

Schlussfolgerung

Durch multimodale Therapiekonzepte mit Einsatz von Chemotherapie, Strahlentherapie und Hyperthermie zusätzlich zur Tumorresektion lässt sich die Prognose von Patienten mit Hochrisikoweichteilsarkomen verbessern.

Abstract

Background

Patients with locally advanced high-grade soft tissue sarcomas treated with tumor resection alone are at risk for both local recurrence and distant metastasis.

Results

There are two phase III trials available for neoadjuvant chemotherapy. The ISG1001 trial showed that anthracycline-based chemotherapy is superior to histology-specific chemotherapy. The EORTC 62961/ESHO-RHT95 trial showed that the efficacy of anthracycline-based chemotherapy can be increased by adding regional deep hyperthermia. After both trials were conducted without a control arm using local therapy alone, the results of the retrospective analysis of the adjuvant EORTC 62931 trial are of particular importance. For patients with poor prognosis based on the Sarculator estimation, adjuvant anthracycline-based chemotherapy was associated with a significant survival benefit compared with local therapy alone. While the value of radiotherapy for high-grade extremity sarcomas is undoubted, the benefit of preoperative radiotherapy for retroperitoneal sarcomas has not been universally demonstrated.

Conclusions

Multimodal therapy concepts that use chemotherapy, radiotherapy, and hyperthermia in addition to tumor resection improve the prognosis of patients with high-risk soft tissue sarcomas.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik III, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland

    L. H. Lindner

  2. Zentrum für Knochen- und Weichteiltumoren (SarKUM), LMU Klinikum, München, Deutschland

    L. H. Lindner

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Correspondence to L. H. Lindner.

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L.H. Lindner erhielt Forschungs- und Reiseunterstützungen von Dr. Sennewald Medizintechnik; Reiseunterstützung und Honorare von PharmaMar, Novartis, Lilly, Eisai, Bayer, Roche, Boehringer Ingelheim Pharma und EL Medconsult.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Lindner, L.H. Multimodale Therapiekonzepte von Weichteilsarkomen bei kurativer und palliativer Therapieabsicht. Onkologie 29, 111–119 (2023). https://doi.org/10.1007/s00761-022-01288-4

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