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Moderne bildgebende Diagnostik bei Weichteilsarkomen

Imaging of soft tissue sarcomas: standard approaches and new strategies

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Zusammenfassung

Weichteilsarkome sind seltene Tumoren, sie machen etwa 1% der malignen Tumoren im Erwachsenenalter aus. Der therapeutische Erfolg beruht bisher wesentlich auf aggressiver chirurgischer Intervention. Für die Planung einer möglichst vollständigen Tumorentfernung besitzt die bildgebende Diagnostik einen hohen Stellenwert. Mit steigender Bedeutung zielgerichteter molekularer Pharmakotherapien werden zukünftig spezifische funktionelle Bildgebungsstrategien zur Abschätzung des individuellen Risikoprofils und zum bildgebenden Therapiemonitoring immer wichtiger.

Abstract

Soft tissue sarcomas are rare malignant neoplasms accounting for only 1% of malignant tumors in adults. Complete surgical resection of the tumor is key for therapeutic success. Comprehensive diagnostic imaging significantly contributes to adequate preoperative planning. With effective targeted molecular pharmacotherapies entering the clinical scenario, functional imaging strategies will have a significant effect on individual risk assessment and will contribute to optimized, noninvasive treatment response monitoring.

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Literatur

  1. Berger F, Saam T, Nikolaou K et al (2007) Initial experiences utilizing perfusion CT in the follow-up of patients with gastrointestinal stromal tumors under imatinib mesylate treatment. Radiology abstract at the scientific assembly ans annual meeting of the radiological society of North America, Abstract SSM09-05

  2. Bland K, McCoy D, Kinard R et al (1987) Application of magnetic resonance imaging and computerized tomography as an adjunct to the surgical management of soft tissue sarcomas. Ann Surg 205:473–481

    Article  PubMed  CAS  Google Scholar 

  3. Choi H, Charnsangavej C, De Castro Faria S et al (2004) CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR 183:1619–1628

    PubMed  Google Scholar 

  4. Choi H, Charnsangavej C, Faria Sc et al (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 25:1753–1759

    Article  PubMed  Google Scholar 

  5. Cuenod CA, Fournier L, Balvay D et al (2006) Tumor angiogenesis: pathophysiology and implications for contrast-enhanced MRI and CT assessment. Abdom Imaging 31:188–193

    Article  PubMed  CAS  Google Scholar 

  6. De Giorgi U, Aliberti C, Benea G et al (2005) Effect of angiosonography to monitor response during imatinib treatment in patients with metastatic gastrointestinal stromal tumors. Clin Cancer Res 11:6171–6176

    Article  CAS  Google Scholar 

  7. Demas BE, Heelan RT, Lane J et al (1988) Soft-tissue sarcomas of the extremities: comparison of MR and CT in determining the extent of disease. AJR 150:615–620

    PubMed  CAS  Google Scholar 

  8. Faivre S, Demetri G, Sargent W et al (2007) Molecular basis for sunitinib efficacy and future clinical development. Nat Rev 6:734–745

    Article  CAS  Google Scholar 

  9. Greene FlPD, Fleming ID, Et AL (eds) (2002) American Joint Committee on Cancer. Soft tissue sarcoma. Springer, New York

  10. Gustafson P, Akerman M, Alvegard TA et al (2003) Prognostic information in soft tissue sarcoma using tumour size, vascular invasion and microscopic tumour necrosis-the SIN-system. Eur J Cancer 39:1568–1576

    Article  PubMed  CAS  Google Scholar 

  11. Heslin MJ, Lewis JJ, Nadler E et al (1997) Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 15:2832–2839

    PubMed  CAS  Google Scholar 

  12. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics. CA: a cancer journal for clinicians 58:71–96

  13. Jin T, Nakatani H, Taguchi T et al (2006) STI571 (Glivec) suppresses the expression of vascular endothelial growth factor in the gastrointestinal stromal tumor cell line, GIST-T1. World J Gastroenterol 12:703–708

    PubMed  CAS  Google Scholar 

  14. Joensuu H, Roberts PJ, Sarlomo-Rikala M et al (2001) Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 344:1052–1056

    Article  PubMed  CAS  Google Scholar 

  15. Kransdorf MJ, Jelinek JS, Moser R Jr (1993) Imaging of soft tissue tumors. Radiol Clin North Am 31:359–372

    PubMed  CAS  Google Scholar 

  16. Lang P, Honda G, Roberts T et al (1995) Musculoskeletal neoplasm: perineoplastic edema versus tumor on dynamic postcontrast MR images with spatial mapping of instantaneous enhancement rates. Radiology 197:831–839

    PubMed  CAS  Google Scholar 

  17. Lassau N, Lamuraglia M, Vanel D et al (2005) Doppler US with perfusion software and contrast medium injection in the early evaluation of isolated limb perfusion of limb sarcomas: prospective study of 49 cases. Ann Oncol 16:1054–1060

    Article  PubMed  CAS  Google Scholar 

  18. Le Tourneau C, Raymond E, Faivre S (2007) Sunitinib: a novel tyrosine kinase inhibitor. A brief review of its therapeutic potential in the treatment of renal carcinoma and gastrointestinal stromal tumors (GIST). Therapeutic Clinic Risk Manag 3:341–348

    Article  Google Scholar 

  19. Lewis JJ, Leung D, Casper ES et al (1999) Multifactorial analysis of long-term follow-up (more than 5 years) of primary extremity sarcoma. Arch Surg 134:190–194

    Article  PubMed  CAS  Google Scholar 

  20. Lewis JJ, Leung D, Woodruff JM et al (1998) Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 228:355–365

    Article  PubMed  CAS  Google Scholar 

  21. Lisle JW, Choi JY, Horton JA et al (2008) Metastatic osteosarcoma gene expression differs in vitro and in vivo. Clin Orthop Relat Res 466:2071–2080

    Article  PubMed  Google Scholar 

  22. Mendenhall WM, Zlotecki RA, Hochwald SN et al (2005) Retroperitoneal soft tissue sarcoma. Cancer 104:669–675

    Article  PubMed  Google Scholar 

  23. Miles KA, Williams RE (2008) Warburg revisited: imaging tumour blood flow and metabolism. Cancer Imaging 8:81–86

    Article  PubMed  CAS  Google Scholar 

  24. Miles KAC, Ca (eds) (2007) Multidetector computed tomography in oncology. Informa Healthcare, UK

  25. Noria S, Davis A, Kandel R et al (1996) Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg 78:650–655

    PubMed  CAS  Google Scholar 

  26. 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 14:1679–1689

    PubMed  CAS  Google Scholar 

  27. Repasky E, Issels R (2002) Physiological consequences of hyperthermia: heat, heat shock proteins and the immune response. Int J Hyperthermia 18:486–489

    Article  PubMed  CAS  Google Scholar 

  28. Rosenberg SA, Tepper J, Glatstein E et al (1982) The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 196:305–315

    Article  PubMed  CAS  Google Scholar 

  29. Schuetze SM (2005) Imaging and response in soft tissue sarcomas. Hematol Oncol Clin North Am 19:471–487

    Article  PubMed  Google Scholar 

  30. Schuetze SM (2006) Utility of positron emission tomography in sarcomas. Curr Opin Oncol 18:369–373

    Article  PubMed  Google Scholar 

  31. Stroobants S, Goeminne J, Seegers M et al (2003) 18FDG-Positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec). Eur J Cancer 39:2012–2020

    Article  PubMed  CAS  Google Scholar 

  32. Stroszczynski C, Jost D, Reichardt P et al (2005) Follow-up of gastro-intestinal stromal tumours (GIST) during treatment with imatinib mesylate by abdominal MRI. Eur Radiol 15:2448–2456

    Article  PubMed  Google Scholar 

  33. Tanabe KK, Pollock RE, Ellis LM et al (1994) Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer 73:1652–1659

    Article  PubMed  CAS  Google Scholar 

  34. Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  PubMed  CAS  Google Scholar 

  35. Tzeng CW, Fiveash JB, Heslin MJ (2006) Radiation therapy for retroperitoneal sarcoma. Expert Rev Anticancer Ther 6:1251–1260

    Article  PubMed  Google Scholar 

  36. Van De Luijtgaarden AC, De Rooy JW, De Geus-Oei LF et al (2008) Promises and challenges of positron emission tomography for assessment of sarcoma in daily clinical practice. Cancer Imaging 8 [Suppl A]:61–68

  37. Van Den Abbeele AD (2008) The lessons of GIST-PET and PET/CT: A new paradigm for imaging. Oncologist 13:8–13

    Article  Google Scholar 

  38. Weiss S (ed) (2001) General considerations. CV Mosby, Philadelphia

  39. Yubao L et al (2007) Gastrointestinal Stromal Tumor (GIST): Correlatice study between 64-detector row CT perfusion and molecular pathology. Radiology abstract at the scientific assembly and annual meeting of the radiological society of North America, abstract SSM09-03

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Berger, F., Winkler, E., Ruderer, C. et al. Moderne bildgebende Diagnostik bei Weichteilsarkomen. Chirurg 80, 175–185 (2009). https://doi.org/10.1007/s00104-008-1594-7

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  • DOI: https://doi.org/10.1007/s00104-008-1594-7

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