Budach V, Dinges S, Budach W
Universitäts-Strahlenklinik, Essen.
Radiologe. 1992 Dec;32(12):606-14.
Soft tissue sarcomas account for under 1% of all cancers in adults. Most soft tissue tumours are benign, only about 1% being characterized clinically and histomorphologically as malignant neoplasms. Since these tumours are often treated by excisional biopsies without any further diagnostic imaging, precise planning of postoperative irradiation therapy is often difficult to achieve. Therefore, all soft tissue tumours with a short history should be regarded as malignant until the contrary has been proven. In general, the mode of tumour resection should be postponed until CT or MR diagnosis is complete and a biopsy of the tumour has been carried out. Whereas benign lesions need only marginal tumour resection, malignant lesions require considerable safety margins. In soft tissue sarcomas of the extremities, which account for 50-60% of all sarcomas, a wide local resection followed by postoperative irradiation with about 66 Gy can guarantee local control rates above 80% and preserve the function of the limb. Radical surgery alone can achieve the same local control, but without the high level of functional integrity. In the case of marginally resectable tumours, preoperative irradiation can induce partial tumour remission and thus allow definitive limb-sparing tumour resection. Recently, multimodal and neoadjuvant therapeutic strategies have been developed. The efficacy of these experimental strategies is not yet proven.
软组织肉瘤在成人所有癌症中占比不到1%。大多数软组织肿瘤是良性的，临床上和组织形态学上仅有约1%被判定为恶性肿瘤。由于这些肿瘤常常通过切除活检进行治疗，而没有进一步的诊断性影像学检查，因此术后放射治疗的精确规划往往难以实现。所以，所有病程较短的软组织肿瘤在未被证伪之前都应被视为恶性。一般而言，肿瘤切除方式应推迟到CT或MR诊断完成且已对肿瘤进行活检之后。良性病变仅需进行肿瘤边缘切除，而恶性病变则需要相当宽的安全切缘。在占所有肉瘤50 - 60%的肢体软组织肉瘤中，广泛局部切除后进行约66 Gy的术后放疗可保证局部控制率超过80%并保留肢体功能。单纯根治性手术可实现相同的局部控制，但无法达到如此高的功能完整性水平。对于切缘可切除的肿瘤，术前放疗可诱导部分肿瘤缓解，从而允许进行确定性的保肢肿瘤切除。最近，已经开发出多模式和新辅助治疗策略。这些实验性策略的疗效尚未得到证实。
