Lise M, Rossi C R, Alessio S, Foletto M
Istituto di Clinica Chirurgica II, Università di Padova, Italy.
Eur J Surg Oncol. 1995 Apr;21(2):125-35. doi: 10.1016/s0748-7983(95)90039-x.
We here outline principles and trends in the treatment of soft tissue sarcomas without distant metastases (M0). Over the last 15 years significant advances have been made in the diagnostic imaging and histological classification of these tumors as well as in their treatment. Magnetic resonance imaging (MRI) has essentially replaced computerized tomography (CT) for the evaluation of the local growth pattern, although the latter is still preferred for the detection of pulmonary metastases. Immunohistochemistry techniques and electron microscopy have improved the histological diagnosis, although the results obtained should always be interpreted in the context of routine light microscopy. Adequate surgical resection and radiotherapy can reduce the incidence of local recurrence, which is still high for head-neck and retroperitoneal sarcomas. Limb-sparing surgery in combination with irradiation and/or intra-arterial or perfusion chemotherapy is considered the treatment of choice in 90% of limb sarcomas, with a local recurrence rate of less than 20%. New radiotherapeutical techniques and anti-neoplastic agents are now under investigation in an attempt to improve local control. There is also a need for a more effective adjuvant chemotherapy. Randomized clinical trials using doxorubicin/ifosfamide and growth factors are now underway.
我们在此概述无远处转移（M0）软组织肉瘤的治疗原则和趋势。在过去15年中，这些肿瘤的诊断成像、组织学分类及其治疗均取得了重大进展。磁共振成像（MRI）在评估局部生长模式方面已基本取代计算机断层扫描（CT），不过CT在检测肺转移方面仍更受青睐。免疫组织化学技术和电子显微镜检查改善了组织学诊断，尽管所得结果应始终结合常规光学显微镜检查结果进行解读。充分的手术切除和放疗可降低局部复发率，头颈部和腹膜后肉瘤的局部复发率仍然较高。保肢手术联合放疗和/或动脉内或灌注化疗被认为是90%肢体肉瘤的首选治疗方法，局部复发率低于20%。目前正在研究新的放射治疗技术和抗肿瘤药物，以试图改善局部控制。还需要更有效的辅助化疗。使用阿霉素/异环磷酰胺和生长因子的随机临床试验正在进行中。
