Rudert M, Burgkart R, Gradinger R, Rechl H
Orthopädische Universitätsklinik Würzburg, Brettreich Strasse 11, Würzburg, Germany.
Chirurg. 2009 Mar;80(3):194-201. doi: 10.1007/s00104-008-1595-6.
Treatment of soft tissue sarcomas requires an individual plan which considers interdisciplinary recommendations and the various clinical situations. Anatomical region, histological grading and typing, and tumor size necessitate adjusted methods of reconstruction. The biopsy should be performed at the institution where the patient is treated. In general surgical resection of the tumor will be the treatment of choice. Adjuvant therapies are applied according to anatomical region and size and grading of the tumor. Surgery alone is recommended only in small (<5 cm), superficial, low-grade sarcomas. Sarcomas larger than 5 cm in diameter should be treated by surgery and radiotherapy, achieving excellent results, although in high-grade sarcomas more than 50% of patients still will experience metastatic disease. In case of locally recurrent disease, surgical revision with tumor-free resection margins followed by radiotherapy should be the aim. This applies even for patients who had had radiotherapy after the first excision. In this case brachytherapy is a good modality of tissue-sparing treatment.
软组织肉瘤的治疗需要一个个体化方案，该方案要考虑多学科建议和各种临床情况。解剖部位、组织学分级和类型以及肿瘤大小需要采用不同的重建方法。活检应在患者接受治疗的机构进行。一般来说，肿瘤的手术切除将是首选治疗方法。辅助治疗根据肿瘤的解剖部位、大小和分级来应用。仅对于小的（<5 cm）、表浅的、低级别肉瘤推荐单纯手术治疗。直径大于5 cm的肉瘤应采用手术和放疗治疗，可取得良好效果，尽管在高级别肉瘤中超过50%的患者仍会发生转移性疾病。对于局部复发性疾病，应以手术切除肿瘤且切缘无瘤，随后进行放疗为目标。这甚至适用于首次切除后接受过放疗的患者。在这种情况下，近距离放疗是一种良好的保留组织的治疗方式。
