Keohan M L, Taub R N
Division of Medical Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Semin Oncol. 1997 Oct;24(5):572-9.
In patients who have advanced soft tissue sarcoma that is no longer localized, systemic chemotherapy is the most reasonable option for treatment. The decision to treat or to use experimental or conventional agents should be based on the clinical assessment of anticipated net benefit in quality of life as well as the remote possibility of complete remission or even cure. Asymptomatic elderly patients with relatively stable disease might best be treated with watchful waiting; whereas younger excellent-performance-status patients should be offered the opportunity of participating in phase II or phase I studies of newer drugs and intensification regimens. Of the currently available single agents, only doxorubicin (or epirubicin) and ifosfamide show response rates greater than 20%; both show a definite dose-response relationship. Dacarbazine shows particular activity in uterine leiomyosarcomas. Combination chemotherapy regimens such as doxorubicin-ifosfamide show a higher response rate, but may be more toxic. New agents are needed. The current progress in our understanding of the molecular biology of sarcomas, and our expanded comprehension of the mechanism of action of cytotoxic drugs and the biology of drug resistance is cause for optimism.
对于患有不再局限于局部的晚期软组织肉瘤的患者，全身化疗是最合理的治疗选择。决定进行治疗或使用实验性或传统药物应基于对生活质量预期净获益的临床评估以及完全缓解甚至治愈的渺茫可能性。病情相对稳定的无症状老年患者可能最好采用观察等待；而年轻、身体状况良好的患者应给予参与新药和强化方案的II期或I期研究的机会。在目前可用的单一药物中，只有多柔比星（或表柔比星）和异环磷酰胺的缓解率大于20%；两者均显示出明确的剂量反应关系。达卡巴嗪在子宫平滑肌肉瘤中显示出特殊活性。多柔比星 - 异环磷酰胺等联合化疗方案显示出更高的缓解率，但毒性可能更大。需要新的药物。我们目前对肉瘤分子生物学的理解取得的进展，以及我们对细胞毒性药物作用机制和耐药生物学的更深入理解，令人感到乐观。
