Lawrence W
Division of Surgical Oncology, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Semin Surg Oncol. 1988;4(1):73-7. doi: 10.1002/ssu.2980040114.
Pretreatment assessment of patients with soft tissue sarcomas of the extremities requires careful attention to a biopsy approach that will establish the precise diagnosis and will not compromise the subsequent definitive operative procedure. Also, staging procedures are required to evaluate the status of both local and distant sites. Limb-sparing surgery for high grade extremity soft tissue sarcomas is a feasible and appropriate approach in approximately 90% of patients with such lesions. Wide gross surgical margins around the sarcoma are the optimal operative approach. Circumstantial evidence is convincing that local treatment failure can be reduced by adjuvant regional radiation treatment when surgical margins are narrow, and end results appear to be equal to those obtained by more extensive surgical resection alone. Adjuvant radiation following operation with optimal gross surgical margins has not been established as adding benefit. Although some groups treating soft tissue sarcomas do use intraarterial chemotherapy in conjunction with these other modalities, there is, as yet, no convincing evidence that this aspect of the multimodality treatment adds to local and/or systemic disease control. The efficacy of adjuvant systemic chemotherapy for high grade soft tissue sarcomas remains to be established within the context of prospective clinical trials.
对四肢软组织肉瘤患者进行预处理评估时，需要特别关注活检方法，既要能明确诊断，又不能影响后续的确定性手术操作。此外，还需要进行分期检查，以评估局部和远处的情况。对于高级别四肢软组织肉瘤，保肢手术对大约90%的此类病变患者来说是一种可行且合适的方法。肉瘤周围广泛的手术切缘是最佳手术方式。有充分的间接证据表明，当手术切缘狭窄时，辅助性区域放射治疗可减少局部治疗失败，最终结果似乎与单纯进行更广泛手术切除的结果相当。术后采用最佳手术切缘并进行辅助放疗是否有益尚未得到证实。尽管一些治疗软组织肉瘤的团队确实将动脉内化疗与其他治疗方式联合使用，但目前尚无令人信服的证据表明这种多模式治疗的这一方面能增强局部和/或全身疾病控制。辅助性全身化疗对高级别软组织肉瘤的疗效仍有待在前瞻性临床试验中确定。
