Nieto Alexander, Albertsmeier Markus, Werner Jens, Di Gioia Dorit, Lindner Lars H, Rauch Josefine, Nachbichler Silke, Belka Claus, Schmidt-Hegemann Nina-Sophie
Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Campus Großhadern, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
Klinik und Poliklinik für Chirurgie, Campus Großhadern, LMU Klinikum, München, Deutschland.
Chirurg. 2022 Jan;93(1):34-39. doi: 10.1007/s00104-021-01498-3. Epub 2021 Sep 15.
Retroperitoneal soft tissue sarcomas (RPS) include tumors of mesenchymal origin with overall well-defined histological subtypes and heterogenic prognosis. For the first time with the publication of the STRASS study, which investigated the value of neoadjuvant radiotherapy in primary RPS, there is phase III evidence for the use of radiotherapy.
The primary objective of the present article is to present the role of neoadjuvant radiotherapy in RPS since the publication of the STRASS study.
We performed a non-systematic literature search. The results of retrospective and observational studies were compared to those of the STRASS study.
In the two of the largest analyses, the surveillance, epidemiology, and end results program (SEER) and the American National Cancer Database (NCDB), an improvement in overall survival due to radiotherapy in RPS could be shown. In contrast to these results, there was no significant improvement in 3‑year abdominal recurrence-free survival in the STRASS study. There was solely a trend to improved abdominal recurrence-free survival in initially unplanned subgroup analyses for patients with liposarcoma as well as low-grade sarcoma but not for leiomyosarcoma or high-grade sarcoma.
Thanks to international collaboration an academic randomized trial was even feasible in such a rare disease as RPS. The results of the STRASS study have relativized the potential benefit of radiotherapy in RPS. A longer follow-up especially regarding the role of radiotherapy in liposarcomas is desirable.
腹膜后软组织肉瘤（RPS）包括间充质起源的肿瘤，其组织学亚型总体明确，预后异质性大。随着STRASS研究的发表，首次对原发性RPS新辅助放疗的价值进行了研究，有Ⅲ期证据支持放疗的使用。
本文的主要目的是介绍自STRASS研究发表以来新辅助放疗在RPS中的作用。
我们进行了非系统性文献检索。将回顾性和观察性研究的结果与STRASS研究的结果进行了比较。
在两项最大规模的分析中，即监测、流行病学和最终结果计划（SEER）以及美国国家癌症数据库（NCDB）中，可以显示放疗可改善RPS的总生存期。与这些结果相反，STRASS研究中3年腹部无复发生存率没有显著改善。在最初未计划的亚组分析中，对于脂肪肉瘤和低级别肉瘤患者，仅存在腹部无复发生存率改善的趋势，而平滑肌肉瘤或高级别肉瘤患者则没有。
由于国际合作，一项学术随机试验甚至在RPS这种罕见疾病中也是可行的。STRASS研究的结果使放疗在RPS中的潜在益处相对化。需要更长时间的随访，特别是关于放疗在脂肪肉瘤中的作用。
