Eilber F R, Huth J F, Mirra J, Rosen G
Department of Surgery/Oncology, University of California, Los Angeles 90024.
Cancer. 1990 Feb 1;65(3 Suppl):660-6. doi: 10.1002/1097-0142(19900201)65:3+<660::aid-cncr2820651308>3.0.co;2-#.
Over the past 10 years there has been significant progress made in the recognition and treatment of soft tissue sarcomas. With the advent of CAT scans and MRI, preoperative delineation of soft tissue tumors has become readily available. The diagnostic use of these modalities in patients presenting with an ill-defined asymptomatic mass has been extremely helpful in terms of screening patients to decide whether or not a biopsy is indicated. These techniques have also provided a much clearer delineation of the anatomic extent of the primary tumor, which has been of great assistance both in radiation therapy treatment calculations as well as in preoperative surgical planning. The recognition that tumor grade is the dominant prognostic variable has resulted in the more common use of a grading system, and a more uniform reporting and stratification of end results. Recent studies with immunohistochemical staining have proven of value in determining the histogenesis of many tumors that in the past were difficult to classify accurately. Most recently the use of flow cytometry suggests that this will also be a valuable adjunct in determining tumor grade and thereby prognosis. The most recent investigations of molecular biologic evaluation of genetic DNA and RNA sequences, as well as of oncogenes are extremely interesting from a diagnostic standpoint and in demonstrating the potential of molecular biologic evaluation for understanding the origin of these tumors. Multimodality therapy with surgery, radiation, chemotherapy, or all three has resulted in a marked improvement in local tumor control for patients with soft tissue sarcomas. The combination of modalities has allowed smaller surgical excisions of the tumor and thereby preservation of the extremity and much of its function. There are currently several different methods of multimodality therapy used including neoadjuvant therapy and postoperative therapy, both of which have been proven efficacious. Chemotherapy is now playing an increased role in clinical investigation and treatment. The availability of Adriamycin, DTIC, cisplatin, and most recently ifosfamide has added several chemotherapeutic agents for use by the clinician. Combination chemotherapy and radiation is of value in the neoadjuvant setting, and several studies are now underway to determine whether postoperative adjuvant chemotherapy is of similar value in reducing systemic spread of disease. Finally, surgical resection of pulmonary metastases has been proven of value in 20% to 25% of patients who subsequently develop metastatic disease. As a result of these advances in several different treatment disciplines, the overall survival rate and quality of life of patients with soft tissue sarcoma have improved markedly over the past 10 years.(ABSTRACT TRUNCATED AT 400 WORDS)
在过去10年里，软组织肉瘤的识别与治疗取得了显著进展。随着计算机断层扫描（CAT扫描）和磁共振成像（MRI）的出现，软组织肿瘤的术前轮廓描绘变得轻而易举。对于出现界限不清的无症状肿块的患者，这些检查手段的诊断性应用在筛选患者以决定是否需要活检方面极为有用。这些技术还能更清晰地描绘出原发肿瘤的解剖范围，这对放射治疗剂量计算以及术前手术规划都有很大帮助。认识到肿瘤分级是主要的预后变量后，分级系统的使用更为普遍，最终结果的报告和分层也更加统一。近期免疫组织化学染色研究已证明在确定许多过去难以准确分类的肿瘤的组织发生方面具有价值。最近流式细胞术的应用表明，这在确定肿瘤分级进而判断预后方面也将是一种有价值的辅助手段。对基因DNA和RNA序列以及癌基因进行分子生物学评估的最新研究，从诊断角度以及在展示分子生物学评估对于理解这些肿瘤起源的潜力方面都极具意义。手术、放疗、化疗或三者联合的多模式治疗已使软组织肉瘤患者的局部肿瘤控制有了显著改善。多种治疗手段的结合使得肿瘤的手术切除范围更小，从而保全了肢体及其大部分功能。目前有几种不同的多模式治疗方法，包括新辅助治疗和术后治疗，两者都已被证明有效。化疗在临床研究和治疗中发挥着越来越重要的作用。阿霉素、达卡巴嗪、顺铂以及最近的异环磷酰胺的出现，为临床医生增加了多种化疗药物。联合化疗和放疗在新辅助治疗中具有价值，目前正在进行多项研究以确定术后辅助化疗在减少疾病全身扩散方面是否具有类似价值。最后，对于20%至25%随后发生转移性疾病的患者，手术切除肺转移瘤已被证明具有价值。由于在几个不同治疗领域的这些进展，软组织肉瘤患者的总体生存率和生活质量在过去10年中得到了显著提高。（摘要截选至400字）
