Sondak V K, Economou J S, Eilber F R
Division of Surgical Oncology, University of Michigan Medical School, Ann Arbor.
Adv Surg. 1991;24:333-59.
The treatment of soft tissue sarcomas continues to pose significant challenges. The past decade has seen a dramatic increase in multimodality therapy for these tumors, with a resultant decrease in the number of amputations performed for extremity lesions. Even with combined modality treatment, however, the prognosis remains grim for most patients with retroperitoneal sarcomas, in which delay in diagnosis and tumor proximity to vital structures hinder the chances for cure. Improved protocols for the treatment of retroperitoneal sarcomas must be developed if we are to match the successes achieved with extremity tumors. As efforts to decrease local recurrence of extremity sarcomas have been largely successful, a new challenge to decrease the frequency of systemic metastases has emerged. Although aggressive surgical approaches to recurrent and metastatic sarcomas can result in long-term survival in some cases, better treatments are needed for those patients whose resections fail or those who are not candidates for resection. Combined modality treatments and new modalities, such as adoptive immunotherapy, need to be carefully evaluated in this group of patients. Enormous strides have been made in the treatment of osteogenic sarcomas and some pediatric soft tissue sarcomas. Additional research into basic tumor biology, as well as major intergroup studies of therapy, will be necessary if we are to duplicate those achievements in the more refractory adult soft tissue sarcomas.
软组织肉瘤的治疗仍然面临重大挑战。在过去十年中，针对这些肿瘤的多模式治疗显著增加，导致因肢体病变而进行截肢手术的数量减少。然而，即使采用联合治疗，大多数腹膜后肉瘤患者的预后仍然严峻，因为诊断延迟和肿瘤与重要结构接近会阻碍治愈的机会。如果我们要取得与肢体肿瘤相同的成功，就必须制定改进的腹膜后肉瘤治疗方案。由于减少肢体肉瘤局部复发的努力在很大程度上取得了成功，因此出现了一个新的挑战，即降低全身转移的频率。尽管对复发性和转移性肉瘤采取积极的手术方法在某些情况下可以实现长期生存，但对于那些手术切除失败或不适合进行切除的患者，仍需要更好的治疗方法。联合治疗和新的治疗方法，如过继性免疫治疗，需要在这组患者中进行仔细评估。在骨肉瘤和一些儿童软组织肉瘤的治疗方面已经取得了巨大进展。如果我们要在更难治的成人软组织肉瘤中复制这些成果，就需要对肿瘤基础生物学进行更多研究，以及开展主要的治疗组间研究。
