Faivre J-C, Le Péchoux C
Département universitaire de radiothérapie-curiethérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, CS 30519, 54511 Vandœuvre-lès-Nancy cedex, France.
Cancer Radiother. 2013 Oct;17(5-6):444-52. doi: 10.1016/j.canrad.2013.07.146. Epub 2013 Sep 3.
Soft tissue sarcoma is a rare entity and heterogeneous disease and its management therefore requires an experienced multidisciplinary team in an expert center. Standard treatment for grade 2 and 3 sarcomas is a conservative, extended surgery planned according to the results of the biopsy, and radiotherapy usually administered postoperatively (or pre-operatively). The indications for preoperative radiotherapy are discussed in a multidisciplinary meeting for locally advanced tumours. The definition of target volumes for conformal radiation therapy requires a good knowledge of the patient record, radioanatomy, as well as a careful reading of surgical and histological reports. The definitions of target volumes combine anatomical and geometrical approach. The gross tumour volume is the visible tumour on MRI preoperatively. The corresponding clinical target volume is defined by a larger longitudinal automatic extension than the radial extension. It is manually corrected taking into account the anatomical barriers to tumour spread. The planning target volume is a concentric automatic margin that may vary from one institution to another, depending on the immobilisation devices and verification of repositioning. Innovative radiotherapy techniques may be used to reduce the size of the margins around target volumes and better protect the organs at risk.
软组织肉瘤是一种罕见且异质性的疾病,因此其治疗需要在专家中心由经验丰富的多学科团队进行。2级和3级肉瘤的标准治疗方法是根据活检结果进行保守的扩大手术,放疗通常在术后(或术前)进行。术前放疗的适应证在针对局部晚期肿瘤的多学科会议上进行讨论。适形放射治疗靶区体积的定义需要充分了解患者病历、放射解剖学,以及仔细阅读手术和组织学报告。靶区体积的定义结合了解剖学和几何学方法。大体肿瘤体积是术前MRI上可见的肿瘤。相应的临床靶区体积通过比径向延伸更大的纵向自动延伸来定义。根据肿瘤扩散的解剖学屏障进行手动校正。计划靶区体积是一个同心自动边界,不同机构可能会有所不同,这取决于固定装置和重新定位的验证情况。可采用创新的放射治疗技术来减小靶区周围边界的大小,并更好地保护危及器官。