Mendenhall William M, Indelicato Daniel J, Scarborough Mark T, Zlotecki Robert A, Gibbs C Parker, Mendenhall Nancy P, Mendenhall Charles M, Enneking William F
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.
Am J Clin Oncol. 2009 Aug;32(4):436-42. doi: 10.1097/COC.0b013e318173a54f.
Soft tissue sarcomas are a relatively rare, heterogeneous group of tumors arising from mesenchymal tissues and occurring almost anywhere in the body. The rate of progression and likelihood of hematogenous dissemination, usually to the lung, is determined primarily by tumor grade. The likelihood of regional spread is low. Pretreatment evaluation includes computed tomography of the primary site and chest and magnetic resonance imaging of the primary tumor. The mainstay of treatment is surgery; wide excision for low-grade lesions and wide or radical (compartmental) resection for high-grade tumors. Often, these procedures cannot be achieved either because of the location and extent of the sarcoma or anticipated functional deficit. Adjuvant preoperative and/or postoperative radiotherapy improves the likelihood of local control and preserves function when adequate margins cannot be achieved with surgery alone. The role of adjuvant chemotherapy is unclear; however, some data suggest the doxorubicin containing regimens may improve the likelihood of cure for high-grade lesions, particularly large tumors arising in the extremities. Prognosis is influenced by a variety of factors, including age, tumor size, histologic grade, depth (superficial or deep), histologic subtype, and site. Approximately 90% and 98% of recurrences are observed within 5 years and 10 years, respectively. Five-year overall survival rates range from approximately 60% to 80%.
软组织肉瘤是一组相对罕见的异质性肿瘤，起源于间充质组织，几乎可发生于身体的任何部位。肿瘤进展速度和血行转移（通常转移至肺）的可能性主要取决于肿瘤分级。区域扩散的可能性较低。治疗前评估包括原发部位和胸部的计算机断层扫描以及原发肿瘤的磁共振成像。治疗的主要手段是手术；低级别病变行广泛切除，高级别肿瘤行广泛或根治性（间室）切除。通常，由于肉瘤的位置和范围或预期的功能缺陷，这些手术无法实施。辅助性术前和/或术后放疗可提高局部控制的可能性，并在仅靠手术无法获得足够切缘时保留功能。辅助化疗的作用尚不清楚；然而，一些数据表明，含阿霉素的方案可能会提高高级别病变，特别是四肢出现的大肿瘤的治愈可能性。预后受多种因素影响，包括年龄、肿瘤大小、组织学分级、深度（浅表或深部）、组织学亚型和部位。分别约90%和98%的复发在5年内和10年内出现。五年总生存率约为60%至80%。
