Ducassou A, Llacer C, Sargos P, Moureau-Zabotto L, Sunyach M-P, Thariat J, Le Péchoux C
IUCT-oncopole, département d'oncologie radiothérapie, institut Claudius-Regaud, 31300 Toulouse, France.
Département d'oncologie radiothérapie, institut régional du cancer de Montpellier, 34070 Montpellier, France.
Cancer Radiother. 2021 Oct;25(6-7):598-602. doi: 10.1016/j.canrad.2021.06.008. Epub 2021 Jun 29.
The quality of the initial management of sarcomas is fundamental because it conditions the patient's quality of life and his overall survival. Radiotherapy should be discussed in a multidisciplinary consultation meeting within the framework of the Netsarc+network. The place of radiotherapy in patients with soft tissue or bone sarcoma depends on the histology and tumour location, knowing that it is most often associated with surgery which remains the main treatment. It is part of the standard treatment for grade II and III deep limb sarcomas of 5cm or greater in size and Ewing's sarcomas. In these indications, conformal radiotherapy with modulation of intensity is used routinely, in combination with IGRT. In other locations, such as retroperitoneal sarcomas or uterine sarcomas, radiotherapy is not a standard of care and must be discussed according to the prognostic criteria related to the patient, the tumour, and the previously received treatments. New techniques, such as proton therapy, hadron therapy (carbon ions) are techniques particularly suited to bone sarcomas considered to be radioresistant. However, large prospective trials are lacking in these rare indications, explaining the lack of recommendations of a high level of evidence.
肉瘤初始治疗的质量至关重要,因为它决定了患者的生活质量和总体生存率。应在Netsarc+网络框架内的多学科会诊会议上讨论放疗问题。软组织或骨肉瘤患者放疗的地位取决于组织学类型和肿瘤位置,要知道放疗通常与手术联合使用,而手术仍是主要治疗方法。放疗是直径5厘米及以上的II级和III级深部肢体肉瘤以及尤文肉瘤标准治疗的一部分。在这些适应证中,常规采用调强适形放疗并结合图像引导放射治疗(IGRT)。在其他部位,如腹膜后肉瘤或子宫肉瘤,放疗并非标准治疗方法,必须根据与患者、肿瘤及先前接受治疗相关的预后标准进行讨论。新技术,如质子治疗、强子治疗(碳离子),是特别适用于被认为对放疗耐药的骨肉瘤的技术。然而,在这些罕见适应证方面缺乏大型前瞻性试验,这就解释了为何缺乏高水平证据的推荐意见。