The role of postoperative radiotherapy in treatment of soft tissue sarcomas

Yıl 2007, Cilt: 22 Sayı: 2, 95 - 103, 01.03.2007

Görkem Aksu Hakan Ağır

Öz

Soft-tissue sarcomas account for approximately 1% of adult malignancies and they occur in up to 50% of cases in the extremities, followed by visceral/retroperitoneal regions. Different histological subtypes exist and primary therapy is predicated on surgical resection with an adequate margin of normal tissue. İn most of the extremity tumors, limb-sparing surgery is possible. Local recurrence rates vary depending on the anatomic site and for high-risk patients, identified by tumor grade, size and site, local control is clearly improved with postoperative adjuvant radiation. In this review, the role of radiotherapy in the treatment of soft tissue sarcomas are analyzed regarding the recent literature.

Anahtar Kelimeler

Sarcoma, Positron-Emission Tomography, Epidemiology, Etiology, Risk Factors, Diagnosis, Neoplasm Staging, Therapy, Radiotherapy

Yumuşak doku sarkomlarının tedavisinde radyoterapinin rolü

Öz

Yumuşak doku sarkomları, yetişkin malignitelerinin %1'ini oluşturmaktadır ve yaklaşık %50'si ekstremite yerleşimli olup, takiben viseral ve retroperitoneal bölgelerde yerleşmektedirler. Çeşitli histolojik alt tipleri vardır ve primer tedavi; uygun cerrahi sınırlar oluşturacak şekilde uygulanan cerrahi rezeksiyondur. Ekstremite yerleşimli tümörlerin çoğunda organ koruyucu cerrahi yaklaşımlar mümkün olmaktadır. Lokal nüks oranları anatomik lokalizasyonlara göre değişkenlik göstermekte ve tümör gradı, boyut ve anatomik lokalizasyon açısından yüksek riskli hastalarda lokal kontrol oranları, ameliyat sonrası adjuvan radyoterapi ile belirgin şekilde artış göstermektedir. Bu yazıda literatürdeki son gelişmelerin ışığı altında, yumuşak doku sarkomlarda radyoterapinin rolü incelendi.

Anahtar Kelimeler

Yumuşak doku sarkomları/tedavi/radyoterapi/cerrahi, pozitron emisyon tomografisi

Kaynakça

• 1. McGinn CJ, Lawrence TS. Soft tissue sarcomas (excluding retroperitoneum). In: Perez CA, Brady LW, editors. Priciples and practice of radiation oncolo g y. 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1998. p. 2051-72.
• 2. Brennan MF, Alektiar KM, Maki RG. Soft tissue Sarcoma. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. p. 1841-91.
• 3. Coindre JM, Terrier P, Guillou L, Le Doussal V, Collin F, Ranchere D, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer 2001;91(10):1914-26.
• 4. Zahm SH, Fraumeni JF Jr. The epidemiology of soft tissue sarcoma. Semin Oncol 1997;24(5):504-14.
• 5. Smith AH, Pearce NE, Fisher DO, Giles HJ, Teague CA, Howard JK. Soft tissue sarcoma and exposure to phenoxyherbicides and chlorophenols in New Zealand. J Natl Cancer Inst 1984;73(5):1111-7.
• 6. Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993;217(1):72-7.
• 7. Brady MS, Gaynor JJ, Brennan MF. Radiation-associated sarcoma of bone and soft tissue. Arch Surg 1992;127(12):1379-85.
• 8. Hardell L, Sandstrom A. Case-control study: soft-tissue sarcomas and exposure to phenoxyacetic acids or chlorophenols. Br J Cancer 1979;39(6):711-7.
• 9. Muller R, Hajdu SI, Brennan MF. Lymphangiosarcoma associated with chronic filarial lymphedema. Cancer 1987;59(1):179-83.
• 10. Vorburger SA, Hunt KK. Experimental approaches. In: Pollock RE, editor. Soft Tissue Sarcomas. Hamilton, Ontario, BC Decker, Inc; 2002. p. 89-109.
• 11. Latres E, Drobnjak M, Pollack D, Oliva MR, Ramos M, Karpeh M, et al. Chromosome 17 abnormalities and TP53 mutations in adult soft tissue sarcomas. Am J Pathol 1994;145(2):345-55.
• 12. Heslin MJ, Smith JK. Imaging of soft tissue sarcomas. Surg Oncol Clin N Am 1999;8(1):91-107.
• 13. Demas BE, Heelan RT, Lane J, Marcove R, Hajdu S, Brennan MF. Soft-tissue sarcomas of the extremities: comparison of MR and CT in determining the extent of disease. AJR Am J Roentgenol 1988;150(3):615-20.
• 14. Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MH, Mankin HJ. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 1998;171(3):759-62.
• 15. Singer S. New diagnostic modalities in soft tissue sarcoma. Semin Surg Oncol 1999;17(1):11-22.
• 16. de Saint Aubain Somerhausen N, Fletcher CD. Softtissue sarcomas: an update. Eur J Surg Oncol 1999;25(2):215-20.
• 17. Demas BE, Heelan RT, Lane J, Marcove R, Hajdu S, Brennan MF. Soft-tissue sarcomas of the extremities: comparison of MR and CT in determining the extent of disease. AJR Am J Roentgenol 1988;150(3):615-20.
• 18. National Institute of Health consensus development panel on limb-sparing treatment of adult soft tissue sarcoma and osteosarcomas. Proceedings of Cancer Treatment Symposium, 1985. p. 1-5.
• 19.Cormier JN, Pollock RE. Soft tissue sarcomas. CA Cancer J Clin 2004;54(2):94-109.
• 20. Tanabe KK, Pollock RE, Ellis LM, Murphy A, Sherman N, Romsdahl MM. Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer 1994;73(6):1652-9.
• 21. Suit HD, Spiro I. Role of radiation in the management of adult patients with sarcoma of soft tissue. Semin Surg Oncol 1994;10(5):347-56.
• 22. Wilson AN, Davis A, Bell RS, O'Sullivan B, Catton C, Madadi F, et al. Local control of soft tissue sarcoma of the extremity: the experience of a multidisciplinary sarcoma group with definitive surgery and radiotherapy. Eur J Cancer 1994;30A(6):746-51.
• 23. Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14(3):859-68.
• 24. Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, 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(1):197-203.
• 25. Geer RJ, Wo o d r u ff J, Casper ES, Brennan MF. Management of small soft-tissue sarcoma of the extremity in adults. Arch Surg 1992;127(11):1285-9.
• 26. Karakousis CP, Emrich LJ, Rao U, Khalil M. Limb salvage in soft tissue sarcomas with selective combination of modalities. Eur J Surg Oncol 1991;17(1):71- 80.
• 27. Singer S, Corson JM, Gonin R, Labow B, Eberlein TJ. Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 1994;219(2):165-73.
• 28.Coindre JM, Terrier P, Bui NB, Bonichon F, Collin F, Le Doussal V, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 1996;14(3):869-77.
• 29. Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996;14(5):1679-89.
• 30.Cheng EY, Dusenbery KE, Winters MR, Thompson RC. Soft tissue sarcomas: preoperative versus postoperative radiotherapy. J Surg Oncol 1996;61(2):90-9.
• 31. Prosnitz LR, Maguire P, Anderson JM, Scully SP, Harrelson JM, Jones EL, et al. The treatment of highgrade soft tissue sarcomas with preoperative therm o r a d i o t h e r a p y. Int J Radiat Oncol Biol Phys 1999;45(4):941-9.
• 32. Peat BG, Bell RS, Davis A, O’Sullivan B, Mahoney J, Manktelow RT, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg 1994;93(5):980-7.
• 33. O’Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002;359(9325):2235-41.
• 34.Jadvar H, Gamie S, Ramanna L, Conti PS. Musculoskeletal system. Semin Nucl Med 2004;34(4):254-61.
• 35.Bombardieri E, Aktolun C, Baum RP, BishofDelaloye A, Buscombe J, Chatal JF, et al. FDG-PET: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 2003;30(12):BP115-24.
• 36.Bredella MA, Caputo GR, Steinbach LS. Value of FDG positron emission tomography in conjunction with MR imaging for evaluating therapy response in patients with musculoskeletal sarcomas. AJR Am J Roentgenol 2002;179(5):1145-50.
• 37. Kumar R, Chauhan A, Kesav Vellimana A, Chawla M. Role of PET/PET-CT in the management of sarcomas. Expert Rev Anticancer Ther 2006;6(8):1241-50.