Adigun I A, Rahman G A
Division of Plastic and Reconstructive Surgery, University of Ilorin Teaching Hospital, Ilorin.
Niger J Med. 2007 Apr-Jun;16(2):94-101. doi: 10.4314/njm.v16i2.37289.
Soft tissue sarcomas (STS) are a heterogeneous group of rare tumours that arise predominantly from the embryonic mesoderm. They present most commonly as an asymptomatic mass originating in an extremity but can occur anywhere in the body, particularly the trunk, retroperitoneum, or the head and neck. They account for about 0.7% of all adult malignancies.
A review of the literature of STS was undertaken with emphasis on current approach in management.
Despite recent advances in the knowledge of the molecular biology of STS, there is yet no identifiable aetiology in most cases. Tru-cut biopsy is a safe, accurate and economical procedure for diagnosing STS. Enough tissue is usually obtained for use in several diagnostic tests such as electron microscopy and cytogenetic analysis. With the advent of Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA), tumours can easily be delineated from muscle groups, bone and neurovascular structures. Surgery remains the main potentially curative therapy for STS. In the last two decades, the role of adjuvant radiotherapy has revolutionized the treatment from a situation where amputation was the standard treatment for extremity STS to the present time where limb sparing surgery is appropriate in more than 90% of patients. Postoperative adjuvant chemotherapy significantly improves the overall and disease free survival for patients with large size and high grade sarcomas.
Optimal results of treatment require multidisciplinary interaction between the referring practitioner, the treating surgeon, the pathologist, the radiotherapist and the chemotherapist.
软组织肉瘤(STS)是一组异质性的罕见肿瘤,主要起源于胚胎中胚层。它们最常表现为起源于四肢的无症状肿块,但可发生于身体的任何部位,尤其是躯干、腹膜后或头颈部。它们约占所有成人恶性肿瘤的0.7%。
对软组织肉瘤的文献进行综述,重点关注当前的治疗方法。
尽管近年来在软组织肉瘤分子生物学知识方面取得了进展,但在大多数情况下仍未明确其病因。粗针活检是诊断软组织肉瘤的一种安全、准确且经济的方法。通常可获取足够的组织用于多种诊断测试,如电子显微镜检查和细胞遗传学分析。随着计算机断层扫描(CT)、磁共振成像(MRI)和磁共振血管造影(MRA)的出现,肿瘤能够很容易地与肌肉群、骨骼和神经血管结构区分开来。手术仍然是软组织肉瘤主要的潜在治愈性治疗方法。在过去二十年中,辅助放疗的作用彻底改变了治疗方式,从过去截肢是四肢软组织肉瘤的标准治疗方法,转变为目前超过90%的患者适合保肢手术。术后辅助化疗显著提高了大尺寸和高级别肉瘤患者的总生存率和无病生存率。
最佳治疗效果需要转诊医生、主治外科医生、病理学家、放疗师和化疗师之间的多学科协作。