Handchir Mikrochir Plast Chir 2015; 47(02): 128-133
DOI: 10.1055/s-0034-1398668
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Trends bei der Strahlenbehandlung nach chirurgischer Entfernung von Weichgewebesarkomen der Extremitäten und des Rumpfes

Current Trends in Radiotherapy Following Surgical Resection of Soft-tissue Sarcoma of the Extremities and Trunk
U. S. Kraus-Tiefenbacher
1   Radioonkologie, Krankenhaus Nordwest, Frankfurt
,
M. Van Kampen
1   Radioonkologie, Krankenhaus Nordwest, Frankfurt
› Author Affiliations
Further Information

Publication History

eingereicht 26 September 2014

akzeptiert 19 January 2015

Publication Date:
21 April 2015 (online)

Zusammenfassung

Neben der zentralen Rolle der Chirurgie hat die Strahlentherapie einen wichtigen Platz in der modernen multimodalen Therapiestrategie von Weichteiltumoren. Sie kann postoperativ als adjuvante Radiotherapie oder präoperativ neoadjuvant bei primär nicht weit im Gesunden resezierbaren Tumoren, selten als definitive primäre Therapie bei Inoperabilität durchgeführt werden. Die adjuvante Radiotherapie führt zu einer Verbesserung sowohl der lokalen Kontrollraten als auch des Überlebens. Aufgrund der vielen unterschiedlichen Entstehungsorte und vielen histologischen Subtypen sollten Patienten mit Weichteilsarkomen an Zentren mit entsprechender wissenschaftlicher und klinischer Expertise behandelt werden. Hinsichtlich der Radioonkologie sollten moderne Konzepte und verfeinerte Techniken individualisiert zum Einsatz kommen.

Abstract

Besides surgery, radiotherapy plays its well-established part in the multimodality treatment of soft-tissue sarcomas. It can be delivered before or after surgery with similar control rates. Adjuvant radiotherapy increases the local control rates as well as the overall survival in intermediate or high-grade soft-tissue sarcomas. Due to the complex and sophisticated nature of the treatment, patients should be referred to specialised centres where modern radiotherapeutic options like intensity modulated radiotherapy and image-guided radiotherapy can be offered.

 
  • Literatur

  • 1 Rosenberg SA, Tepper J, Glatstein E et al. The treatment of soft-tissue sarcomas of the extremities. Prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982; 196: 305-315
  • 2 Pisters PW, Harrison LB, Leung DH et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996; 14: 859-868
  • 3 Yang JC, Chang AE, Baker AR et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998; 16: 197-203
  • 4 Choong PF, Petersen IA, Nascimento AG et al. Is radiotherapy important for low-grade soft tissue sarcoma of the extremity?. Clin Orthop Relat Res 2001; 387: 191-199
  • 5 Jebsen N, Trovik CS, Bauer HC et al. Radiotherapy to improve local control regardless of surgical margin and malignancy grade in extremity and trunk wall soft tissue sarcoma: a Scandinavian sarcoma group study. Int J Radiat Oncol Biol Phys 2008; 71: 1196-1203
  • 6 Smapath S, Hitchcock YJ, Shreive DC et al. Radiotherapy and extent of surgical resection in retroperitoneal soft-tissue sarcoma: multi-insitutional analysis of 261 patients. J Surg Oncol 2010; 101: 341-350
  • 7 Wolden SL, Anderson JR, Crist WM et al. Indications for radiotherapy and chemotherapy after complete resection in rhabdomyosarcoma; A report from the Intergroup Rhabdomyosarcom Studies I to III. C. Clin Oncol 1999; 17: 3468-3475
  • 8 Gutierrez JC, Perez EA, Franceschi D et al. Outcomes for soft-tissue sarcoma in 8249 cases from a large state cancer registry. J Surg Res 2007; 141: 105-114
  • 9 Koshy M, Rich SE, Mohiuddin MM. Improved survival with radiation therapy in high-grade soft tissue sarcomas of the extremities a SEER analysis. Int J Radit Oncol Biol Phys 2010; 77: 203-209
  • 10 Zhou Z, Mc Dade TP, Simons JP et al. Surgery and radiotherapy for retroperitoneal and abdominal sarcoma: both necessary and sufficient. Arch Surg 2010; 45: 426-443
  • 11 Barkley Jr HT, Martin RG, Romsdahl MM et al. Treatment of soft tissue sarcomas by preoperative irradiation and conservative surgical resection. Int J Radiat Oncol Biol Phys 1988; 14: 693-699
  • 12 Suit HD, Spiro I. Role of radiation in the management of adult patients with sarcoma of soft tissue. Semin Surg Oncol 1994; 10: 347-356
  • 13 O’Sullivan B, Davis AM, Turcotte R et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002; 359: 2235-2241
  • 14 Zagars GK, Ballo MT, Pisters PW et al. Preoperative vs. postoperative radiation therapy for soft tissue sarcoma: a retrospective comparative evaluation of disease outcome. Int J Radiat Oncol Biol Phys 2003; 56: 482-488
  • 15 Davis AM, O’Sullivan B, Turcotte R et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol 2005; 75: 48-53
  • 16 Cheng EY, Dusenbery KE, Winters MR et al. Soft tissue sarcomas: preoperative versus postoperative radiotherapy. J Surg Oncol 1996; 61: 90-99
  • 17 Carter RJ, Martinez SR, Tamurian RM et al. Radiographic and histologic response to neaoadjuvant radiotherapy in patients with soft tissue sarcoma. Ann Surg Oncol 2010; 17: 2578-2584
  • 18 Roberge D, Skamene T, Nahal A et al. Radiological and pathological response following pre-operative radiotherapy for soft-tissue sarcoma. Radiother Oncol 2010; 97: 404-407
  • 19 Sindelar WF, Kinsella TJ, Chen PW et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg 1993; 128: 402-410
  • 20 Alektiar KM, Hu K, Anderson L et al. High-dose-rate intraoperative radiation therapy (HDRIORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2000; 47: 157-163
  • 21 Rachbauer F, Sztankay A, Kreczy A et al. High-dose-rate intraoperative brachytherapy (IOHDR) using fl ab technique in the treatment of soft tissue sarcomas. Strahlenther Onkol 2003; 179: 480-485
  • 22 Niewald M, Fleckenstein J, Licht N et al. Intraoperative radiotherapy (IORT) combined with external beam radiotherapy (EBRT) for soft-tissue sarcomas – a retrospective evaluation of the Homburg experience in the years 1995–2007. Radiat Oncol 2009; 4: 32
  • 23 Delannes M, Thomas L, Martel P et al. Low-dose intraoperative brachytherapy combined with external beam irradiation in the conservative treatment of soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2000; 47: 165-169
  • 24 Kretzler A, Molls M, Gradinger R et al. Intraoperative radiotherapy of soft tissue sarcoma of the extremity. Strahlenther Oncol 2004; 180: 365-370
  • 25 Rudert M, Winkler C, Holzapfel BM et al. An new modification of combining vacuum therapy and brachytherapy in large subfascial soft-tissue sarcoma of the extremities. Strahlenther Oncol 2010; 186: 224-228
  • 26 Van Kampen M, Eble MJ, Lehnert Th et al. Correlation of intraoperatively irradiated volume and fibrosis in patients with soft tissue sarcoma of the extremities. Int J Radiat Oncol Biol Phys 2001; 51: 94-99
  • 27 Beltrami C, Rüdoger HA, Mela MM et al. Limb salvage surgery in combination with brachytherapy and external beam radiation for high-grade soft tissue sarcoma. Eur J Surg Oncol 2008; 348: 811-816
  • 28 Alektiar KM, Leung D, Zelefsky MJ et al. Adjuvant brachytherapy for primary high-grade soft tissue sarcoma of the extremity. Ann Surg Oncol 2002; 9: 48-56
  • 29 Paumier A, Le Pechoux C, Beaudre A et al. IMRT or conformal radiotherapy for adjuvant treatment of retroperitoneal sarcoma?. Radiother Oncol 2011; 99: 73-78
  • 30 Alektiar KM, Brennan MF, Healey JH et al. Impact of intensity-modulated radiotherapy on local control in primary soft-tissue sarcoma. J Clin Oncol 2008; 26: 3440-3444
  • 31 Folkert MR, Singer S, Brennan MF et al. Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity. J Clin Oncol. 2014; 32: 3236-3241
  • 32 Schwarz R, Krüll A, Engenhart-Cabillic R et al. European results of neutron therapy in soft tissue sarcomas. Recent Results Cancer Res 1998; 150: 100-112
  • 33 Greiner R, Munkel G, Kann R et al. Pion irradiation at Paul Scherrer Institu e. Results of dynamic treatment of unresectable soft tissue sarcoma. Strahlenther Onkol 1990; 166: 30-33
  • 34 Hug EB, Loredo LN, Slater JD et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 1999; 91: 432-439
  • 35 Debus J, Schulz-Ertner D, Schad L et al. Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys 2000; 47: 591-596
  • 36 Schulz-Ertner D, Karger CP, Feuerhake A et al. Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas. Int J Radiat Oncol Biol Phys 2007; 68: 449-457