Issels Rolf D
University Hospital Medical Center Grosshadern, Medical Clinic III and Helmholtz Zentrum münchen - German Research Center for Environmetal Health, Munich, Germany.
Curr Opin Oncol. 2008 Jul;20(4):438-43. doi: 10.1097/CCO.0b013e3283025e50.
On the basis of the definition of high-risk soft tissue sarcomas and prognostic factors, the most recent developments of preoperative treatment strategies with special emphasis on regional hyperthermia combined chemotherapy are reviewed.
The most important prognostic factors (e.g. size, grade, depth and resection margins) for localized soft tissue sarcomas have been defined to predict the probability of sarcoma-specific death providing a useful tool for patient stratification and clinical trial eligibility determination that are also relevant in the outcome of paediatric patients with adult type soft tissue sarcomas. Clinical research on innovative preoperative treatment strategies has essentially focused on the combination of preoperative radiochemotherapy or chemotherapy alone, but unfortunately the reported results are based upon retrospective analysis or nonrandomized phase II studies with small sample size. For the use of regional hyperthermia (RHT) therapy, phase II studies have advocated a possible benefit of the use of regional hyperthermia in combination with chemotherapy targeting the heating field to the region of tumour burden. The preliminary results of a completed European Organization for Research and Treatment of Cancer-European Society of Hyperthermic Oncology intergroup randomized phase III trial for the most common types of adult high-risk soft tissue sarcomas demonstrate a significant benefit in the clinical outcome of patients receiving regional hyperthermia therapy.
Regional hyperthermia combined with preoperative and postoperative chemotherapy offers a new appropriate treatment option for high-risk soft tissue sarcomas.
基于高危软组织肉瘤的定义和预后因素，对术前治疗策略的最新进展进行综述，特别强调区域热疗联合化疗。
已明确局部软组织肉瘤最重要的预后因素（如大小、分级、深度和手术切缘），以预测肉瘤特异性死亡的概率，为患者分层和临床试验资格判定提供有用工具，这对成人型软组织肉瘤的儿科患者的预后也具有相关性。关于创新术前治疗策略的临床研究主要集中在术前放化疗或单纯化疗的联合应用上，但遗憾的是，所报道的结果基于回顾性分析或小样本量的非随机II期研究。对于区域热疗（RHT）治疗，II期研究主张将区域热疗与针对热疗区域的肿瘤负荷进行化疗联合使用可能有益。一项针对最常见类型的成人高危软组织肉瘤完成的欧洲癌症研究与治疗组织-欧洲热肿瘤学会联合组随机III期试验的初步结果表明，接受区域热疗的患者临床结局有显著益处。
区域热疗联合术前和术后化疗为高危软组织肉瘤提供了一种新的合适治疗选择。
