Casali Paolo G, Picci Piero
Adult Sarcoma Medical Oncology Unit, Istituto Nazionale Tumori, Milano, Italy.
Curr Opin Oncol. 2005 Jul;17(4):361-5. doi: 10.1097/01.cco.0000166652.15546.4f.
To review current state-of-the-art knowledge about adjuvant medical therapy in adult soft tissue sarcomas.
Most recent contributions have added nonrandomized evidence to previously available controlled clinical trials, which were undertaken from the 1970s. Again, results are conflicting, with a limited benefit suggested by some retrospective analyses and denied by others. While a delay in relapse is likely to occur in a fraction of patients treated with adjuvant chemotherapy, a permanent benefit has been more difficult to prove. This result is consistent with findings from previous clinical trials, which pointed to a slight benefit from Doxorubicin-based adjuvant chemotherapy and a possibly higher, although less evidence-based, benefit from anthracycline plus Ifosfamide regimens.
Overall, adjuvant chemotherapy may give some benefit in soft tissue sarcoma. If any, it is likely to be of limited degree, confined to the highest-risk patients, and requiring a fully active chemotherapy regimen. This was mainly shown for extremity soft tissue sarcoma but may also apply to other primary sites. The value of molecular-targeted therapy as an adjuvant for high-risk gastrointestinal stromal tumor patients is a different subject awaiting long-term results of ongoing trials.
回顾成人软组织肉瘤辅助性药物治疗的当前最新知识。
最近的研究成果在20世纪70年代开展的现有对照临床试验基础上增加了非随机证据。结果再次出现矛盾,一些回顾性分析表明获益有限,而另一些分析则予以否定。虽然接受辅助化疗的部分患者可能会出现复发延迟,但更难证明有永久性获益。这一结果与先前临床试验的结果一致,先前的临床试验表明基于阿霉素的辅助化疗有轻微获益,而蒽环类药物加异环磷酰胺方案的获益可能更高,尽管证据较少。
总体而言,辅助化疗可能对软组织肉瘤有一定益处。如果有的话,其程度可能有限,仅限于高危患者,且需要采用充分有效的化疗方案。这主要在肢体软组织肉瘤中得到证实,但也可能适用于其他原发部位。分子靶向治疗作为高危胃肠道间质瘤患者辅助治疗的价值是另一个话题,有待正在进行的试验的长期结果。