Peiper M, Hegewisch-Becker S, Langwieler T E, Bloechle C, Izbicki J R
Abteilung für Allgemeinchirurgie, Universitäts-Krankenhaus Eppendorf.
Schweiz Med Wochenschr. 1999 Oct 23;129(42):1545-53.
Soft tissue sarcomas embrace a wide variety of rare tumours. This often means excision without wide margins, and the unexpected malignancy leads to diversity of postoperative treatment. As a rule all lesions of a soft tissue tumour should be biopsied if persisting for more than 6 weeks. The extent of the biopsy is determined by the tumour characteristics, but should not aggravate later resection of a malignant tumour. Preoperative diagnostic studies should be standardised and include MNR, while the tumour is characterised according to the recent edition of the UICC GTNM system. The primary tumour should be excised in a limb-sparing way with wide margins, if necessary including the neighbouring fascia. Local recurrence should be approached aggressively like primary tumours, with curative intention. In cases of distant metastases, which usually occur in the lungs, a grading-associated approach is necessary. In G3 metastases chemotherapy should be administered before the surgical intervention. Radiation therapy is saved for patients in whom the tumour cannot be resected with wide margins or is larger than 10 cm maximum diameter. In the light of current knowledge, radiation therapy should be given as an adjuvant for patients whose tumour was resected without wide margins and for tumours larger than 10 cm in diameter. The use of palliative chemotherapy is still controversial and identification of new prognostic markers for patient selection is necessary. Since most patients with soft tissue sarcoma die from distant metastases and not the primary or locally recurrent tumour, the need for effective chemotherapy in an adjuvant setting is obvious. Controlled studies with as many enrolled patients as possible are necessary if valid data are to be collected. The management of soft tissue sarcoma patients is in principle multidisciplinary and should be confined to specialised centres.
软组织肉瘤包含多种罕见肿瘤。这通常意味着无法进行广泛切缘的切除，而且意外的恶性程度导致术后治疗的多样性。通常，软组织肿瘤的所有病变若持续超过6周均应进行活检。活检范围由肿瘤特征决定，但不应加重后续恶性肿瘤的切除难度。术前诊断研究应标准化，包括磁共振成像（MNR），同时根据国际抗癌联盟（UICC）最新版的GTNM系统对肿瘤进行分类。如果必要，包括邻近的筋膜，应采用保肢方式广泛切除原发性肿瘤。局部复发应像原发性肿瘤一样积极处理，目的是治愈。对于通常发生在肺部的远处转移病例，需要采取与分级相关的方法。在G3级转移的情况下，应在手术干预前进行化疗。对于肿瘤无法进行广泛切除或最大直径大于10厘米的患者，可采用放射治疗。根据目前的知识，对于肿瘤切除切缘不广泛的患者以及直径大于10厘米的肿瘤患者，应给予放射治疗作为辅助治疗。姑息化疗的使用仍存在争议，因此有必要确定新的预后标志物以进行患者选择。由于大多数软组织肉瘤患者死于远处转移，而非原发性或局部复发性肿瘤，显然在辅助治疗中需要有效的化疗。如果要收集有效数据，就需要进行尽可能多患者入组的对照研究。软组织肉瘤患者的管理原则上是多学科的，应局限于专门的中心。
