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Erschienen in: InFo Hämatologie + Onkologie 1/2018

09.02.2018 | Sarkome | zertifizierte fortbildung

Perioperative Behandlungskonzepte

Therapie von Hochrisiko-Weichteilsarkomen bei Erwachsenen

verfasst von: Gesa Schuebbe, Dorit Di Gioia, Falk Roeder, Hans Roland Dürr, Martin Angele, Rolf Issels, Prof. Dr. med. Lars H. Lindner

Erschienen in: InFo Hämatologie + Onkologie | Ausgabe 1/2018

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Zusammenfassung

Weichteilsarkome stellen Behandler aufgrund ihrer Seltenheit und Vielgestaltigkeit vor große Herausforderungen — sowohl hinsichtlich der Diagnostik als auch der Therapie. Lesen Sie im folgende Beitrag, wie Hochrisiko-Weichteilsarkome vor der Operation behandelt werden sollten.
Literatur
1.
Zurück zum Zitat Schütte J et al. Onkopedia Leitlinien: Weichgewebssarkome (Weichteilsarkome) des Erwachsenen. 2017. https://www.onkopedia.com/de/onkopedia/guidelines/weichgewebssarkome-weichteilsarkome-des-erwachsenen/@@view/html/index.html. Abgerufen am 29.01.2018. Schütte J et al. Onkopedia Leitlinien: Weichgewebssarkome (Weichteilsarkome) des Erwachsenen. 2017. https://​www.​onkopedia.​com/de/onkopedia/guidelines/weichgewebssarkome-weichteilsarkome-des-erwachsenen/@@view/html/index.html. Abgerufen am 29.01.2018.
2.
Zurück zum Zitat Schlemmer M et al. Weichteilsarkome im Erwachsenenalter. In: Hiddemann W, Bartram CR (Herausgeber). Die Onkologie. 2010. Heidelberg: Springer Medizin Verlag. Schlemmer M et al. Weichteilsarkome im Erwachsenenalter. In: Hiddemann W, Bartram CR (Herausgeber). Die Onkologie. 2010. Heidelberg: Springer Medizin Verlag.
3.
Zurück zum Zitat von Mehren M et al. Soft Tissue Sarcoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14(6):758–86.CrossRef von Mehren M et al. Soft Tissue Sarcoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14(6):758–86.CrossRef
4.
Zurück zum Zitat Stiller CA et al. Descriptive epidemiology of sarcomas in Europe: Report from the RARECARE project. Eur J Cancer. 2013;49(3):684–95.CrossRefPubMed Stiller CA et al. Descriptive epidemiology of sarcomas in Europe: Report from the RARECARE project. Eur J Cancer. 2013;49(3):684–95.CrossRefPubMed
5.
6.
Zurück zum Zitat Gustafson P et al. Soft tissue sarcoma should be treated at a tumor center. A comparison of quality of surgery in 375 patients. Acta Orthop Scand. 1994;65(1):47–50.CrossRefPubMed Gustafson P et al. Soft tissue sarcoma should be treated at a tumor center. A comparison of quality of surgery in 375 patients. Acta Orthop Scand. 1994;65(1):47–50.CrossRefPubMed
7.
Zurück zum Zitat Lehnhardt M et al. [Importance of specialized centers in diagnosis and treatment of extremity-soft tissue sarcomas. Review of 603 cases]. Chirurg. 2009;80(4):341–7.CrossRefPubMed Lehnhardt M et al. [Importance of specialized centers in diagnosis and treatment of extremity-soft tissue sarcomas. Review of 603 cases]. Chirurg. 2009;80(4):341–7.CrossRefPubMed
8.
Zurück zum Zitat ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii102–12.CrossRef ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii102–12.CrossRef
9.
Zurück zum Zitat Fletcher CDM, Unni KK, Mertens F. (Herausgeber), Pathology and Genetics of Tumours of Soft Tissue and Bone. World Health Organization Classification of Tumours. 2002. Lyon: IARC Press. Fletcher CDM, Unni KK, Mertens F. (Herausgeber), Pathology and Genetics of Tumours of Soft Tissue and Bone. World Health Organization Classification of Tumours. 2002. Lyon: IARC Press.
10.
Zurück zum Zitat Lindner LH (Herausgeber). Tumorzentrum München. MANUAL Knochentumoren und Weichteilsarkom — Empfehlungen zur Diagnostik, Therapie und Nachsorge. 6. Auflage. 2017. Germering: W. Zuckschwerdt Verlag. Lindner LH (Herausgeber). Tumorzentrum München. MANUAL Knochentumoren und Weichteilsarkom — Empfehlungen zur Diagnostik, Therapie und Nachsorge. 6. Auflage. 2017. Germering: W. Zuckschwerdt Verlag.
11.
Zurück zum Zitat Coindre JM et al. Grading of soft tissue sarcomas: review and update. Arch Pathol Lab Med. 2006;130(10):1448–53.PubMed Coindre JM et al. Grading of soft tissue sarcomas: review and update. Arch Pathol Lab Med. 2006;130(10):1448–53.PubMed
12.
Zurück zum Zitat Taeger G et al. Isolierte Extremitätenperfusion zur lokalen Tumorkontrolle an den Gliedmaßen. Onkologe. 2009;15(4): 382–88.CrossRef Taeger G et al. Isolierte Extremitätenperfusion zur lokalen Tumorkontrolle an den Gliedmaßen. Onkologe. 2009;15(4): 382–88.CrossRef
13.
Zurück zum Zitat Pinedo HM, Verweij J. The treatment of soft tissue sarcomas with focus on chemotherapy: a review. Radiother Oncol. 1986;5(3):193–205.CrossRefPubMed Pinedo HM, Verweij J. The treatment of soft tissue sarcomas with focus on chemotherapy: a review. Radiother Oncol. 1986;5(3):193–205.CrossRefPubMed
14.
Zurück zum Zitat van Oosterom AT et al. Results of randomised studies of the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) with two different ifosfamide regimens in first- and second-line chemotherapy in advanced soft tissue sarcoma patients. Eur J Cancer. 2002;38(18):2397–406.CrossRefPubMed van Oosterom AT et al. Results of randomised studies of the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) with two different ifosfamide regimens in first- and second-line chemotherapy in advanced soft tissue sarcoma patients. Eur J Cancer. 2002;38(18):2397–406.CrossRefPubMed
15.
Zurück zum Zitat Eriksson M. Histology-driven chemotherapy of soft-tissue sarcoma. Ann Oncol. 2010;21 Suppl 7:vii270–6.PubMed Eriksson M. Histology-driven chemotherapy of soft-tissue sarcoma. Ann Oncol. 2010;21 Suppl 7:vii270–6.PubMed
16.
Zurück zum Zitat Italiano A et al. Effect of adjuvant chemotherapy on survival in FNCLCC grade 3 soft tissue sarcomas: a multivariate analysis of the French Sarcoma Group Database. Ann Oncol. 2010;21(12):2436–41.CrossRefPubMed Italiano A et al. Effect of adjuvant chemotherapy on survival in FNCLCC grade 3 soft tissue sarcomas: a multivariate analysis of the French Sarcoma Group Database. Ann Oncol. 2010;21(12):2436–41.CrossRefPubMed
17.
Zurück zum Zitat Frustaci S. et al. Adjuvant Chemotherapy for Adult Soft Tissue Sarcomas of the Extremities and Girdles: Results of the Italian Randomized Cooperative Trial. J Clin Oncol. 2001;19(5):1238–47.CrossRefPubMed Frustaci S. et al. Adjuvant Chemotherapy for Adult Soft Tissue Sarcomas of the Extremities and Girdles: Results of the Italian Randomized Cooperative Trial. J Clin Oncol. 2001;19(5):1238–47.CrossRefPubMed
18.
Zurück zum Zitat Ohne Autor. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Meta-analysis Collaboration. Lancet. 1997;350(9092):1647–54.CrossRef Ohne Autor. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Meta-analysis Collaboration. Lancet. 1997;350(9092):1647–54.CrossRef
19.
Zurück zum Zitat Pervaiz N et al. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer. 2008;113(3):573–81.CrossRefPubMed Pervaiz N et al. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer. 2008;113(3):573–81.CrossRefPubMed
20.
Zurück zum Zitat Woll PJ et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol. 2012;13(10):1045–54.CrossRefPubMed Woll PJ et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol. 2012;13(10):1045–54.CrossRefPubMed
21.
Zurück zum Zitat Gortzak E et al. A randomised phase II study on neo-adjuvant chemotherapy for ‚high-risk‘ adult soft-tissue sarcoma. Eur J Cancer. 2001;37(9):1096–103.CrossRefPubMed Gortzak E et al. A randomised phase II study on neo-adjuvant chemotherapy for ‚high-risk‘ adult soft-tissue sarcoma. Eur J Cancer. 2001;37(9):1096–103.CrossRefPubMed
22.
Zurück zum Zitat Meric F et al. Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas. Cancer. 2002;95(5):1120–6.CrossRefPubMed Meric F et al. Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas. Cancer. 2002;95(5):1120–6.CrossRefPubMed
23.
Zurück zum Zitat Kraybill WG et al. Phase II study of neoadjuvant chemotherapy and radiation therapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. J Clin Oncol. 2006;24(4):619–25.CrossRefPubMed Kraybill WG et al. Phase II study of neoadjuvant chemotherapy and radiation therapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. J Clin Oncol. 2006;24(4):619–25.CrossRefPubMed
24.
Zurück zum Zitat Issels RD et al. Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol. 2017;18(11):e630.CrossRefPubMed Issels RD et al. Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol. 2017;18(11):e630.CrossRefPubMed
25.
Zurück zum Zitat Chen Y et al. Radiographic response to neoadjuvant therapy and its impact on scope of surgery and prognosis in stage IIB/III soft tissue sarcomas. BMC Cancer. 2013;11;13:591. Chen Y et al. Radiographic response to neoadjuvant therapy and its impact on scope of surgery and prognosis in stage IIB/III soft tissue sarcomas. BMC Cancer. 2013;11;13:591.
26.
Zurück zum Zitat Gronchi A et al. sarcomaFull-dose neoadjuvant anthracycline + ifosfamide chemotherapy is associated with a relapse free survival (RFS) and overall survival (OS) benefit in localized high-risk adult soft tissue sarcomas (STS) of the extremities and trunk wall: Interim analysis of a prospective randomized trial. Ann Oncol. 2016;27(suppl_6);Abstr LBA6_PR.CrossRef Gronchi A et al. sarcomaFull-dose neoadjuvant anthracycline + ifosfamide chemotherapy is associated with a relapse free survival (RFS) and overall survival (OS) benefit in localized high-risk adult soft tissue sarcomas (STS) of the extremities and trunk wall: Interim analysis of a prospective randomized trial. Ann Oncol. 2016;27(suppl_6);Abstr LBA6_PR.CrossRef
27.
Zurück zum Zitat Gronchi A et al. Short, full-dose adjuvant chemotherapy (CT) in high-risk adult soft tissue sarcomas (STS): long-term follow-up of a randomized clinical trial from the Italian Sarcoma Group and the Spanish Sarcoma Group. Ann Oncol. 2016;27(12):2283–88.CrossRefPubMed Gronchi A et al. Short, full-dose adjuvant chemotherapy (CT) in high-risk adult soft tissue sarcomas (STS): long-term follow-up of a randomized clinical trial from the Italian Sarcoma Group and the Spanish Sarcoma Group. Ann Oncol. 2016;27(12):2283–88.CrossRefPubMed
28.
Zurück zum Zitat Gronchi A et al. Short, full-dose adjuvant chemotherapy in high-risk adult soft tissue sarcomas: a randomized clinical trial from the Italian Sarcoma Group and the Spanish Sarcoma Group. J Clin Oncol. 2012;30(8):850–6.CrossRefPubMed Gronchi A et al. Short, full-dose adjuvant chemotherapy in high-risk adult soft tissue sarcomas: a randomized clinical trial from the Italian Sarcoma Group and the Spanish Sarcoma Group. J Clin Oncol. 2012;30(8):850–6.CrossRefPubMed
29.
Zurück zum Zitat Gronchi A et al. Histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001): an international, open-label, randomised, controlled, phase 3, multicentre trial. Lancet Oncol. 2017;18(6):812–22.CrossRefPubMed Gronchi A et al. Histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001): an international, open-label, randomised, controlled, phase 3, multicentre trial. Lancet Oncol. 2017;18(6):812–22.CrossRefPubMed
30.
Zurück zum Zitat Lindner LH, Issels R. Improved Overall Survival (OS) by Neoadjuvant Therapy in Patients (pts) with High-Risk Soft Tissue Sarcoma (HR-STS) of Extremity (E) and Non-extremity (NE). CTOS Annual Meeting. 2017;Abstr #2803418. Lindner LH, Issels R. Improved Overall Survival (OS) by Neoadjuvant Therapy in Patients (pts) with High-Risk Soft Tissue Sarcoma (HR-STS) of Extremity (E) and Non-extremity (NE). CTOS Annual Meeting. 2017;Abstr #2803418.
31.
Zurück zum Zitat Lepock JR. How do cells respond to their thermal environment? Int J Hyperthermia. 2005;21(8):681–7.CrossRefPubMed Lepock JR. How do cells respond to their thermal environment? Int J Hyperthermia. 2005;21(8):681–7.CrossRefPubMed
32.
Zurück zum Zitat Zaarur N et al. Targeting heat shock response to sensitize cancer cells to proteasome and Hsp90 inhibitors. Cancer Res. 2006;66(3):1783–91.CrossRefPubMed Zaarur N et al. Targeting heat shock response to sensitize cancer cells to proteasome and Hsp90 inhibitors. Cancer Res. 2006;66(3):1783–91.CrossRefPubMed
33.
Zurück zum Zitat Noessner E et al. Tumor-derived heat shock protein 70 peptide complexes are cross-presented by human dendritic cells. J Immunol. 2002;169(10):5424–32.CrossRefPubMed Noessner E et al. Tumor-derived heat shock protein 70 peptide complexes are cross-presented by human dendritic cells. J Immunol. 2002;169(10):5424–32.CrossRefPubMed
34.
Zurück zum Zitat Milani V et al. Heat shock protein 70: role in antigen presentation and immune stimulation. Int J Hyperthermia. 2002;18(6):563–75.CrossRefPubMed Milani V et al. Heat shock protein 70: role in antigen presentation and immune stimulation. Int J Hyperthermia. 2002;18(6):563–75.CrossRefPubMed
35.
Zurück zum Zitat Krawczyk PM et al. Mild hyperthermia inhibits homologous recombination, induces BRCA2 degradation, and sensitizes cancer cells to poly (ADP-ribose) polymerase-1 inhibition. Proc Natl Acad Sci U S A. 2011;108(24):9851–6.CrossRefPubMedPubMedCentral Krawczyk PM et al. Mild hyperthermia inhibits homologous recombination, induces BRCA2 degradation, and sensitizes cancer cells to poly (ADP-ribose) polymerase-1 inhibition. Proc Natl Acad Sci U S A. 2011;108(24):9851–6.CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Issels R et al. Hallmarks of hyperthermia in driving the future of clinical hyperthermia as targeted therapy: translation into clinical application. Int J Hyperthermia. 2016;32(1):89–95.CrossRefPubMed Issels R et al. Hallmarks of hyperthermia in driving the future of clinical hyperthermia as targeted therapy: translation into clinical application. Int J Hyperthermia. 2016;32(1):89–95.CrossRefPubMed
37.
Zurück zum Zitat Roeder F. Neoadjuvante/adjuvante Strahlentherapie beim Weichteilsarkom. Journal Onkologie. 2015;1:41–50. Roeder F. Neoadjuvante/adjuvante Strahlentherapie beim Weichteilsarkom. Journal Onkologie. 2015;1:41–50.
38.
Zurück zum Zitat O’Sullivan B et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41.CrossRefPubMed O’Sullivan B et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41.CrossRefPubMed
39.
Zurück zum Zitat Zagars GK 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(2):482–8.CrossRefPubMed Zagars GK 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(2):482–8.CrossRefPubMed
40.
Zurück zum Zitat Roeder F et al. A clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma. BMC Cancer. 2012;12:287.CrossRefPubMedPubMedCentral Roeder F et al. A clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma. BMC Cancer. 2012;12:287.CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Pawlik TM et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol. 2006;13(4):508–17.CrossRefPubMed Pawlik TM et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol. 2006;13(4):508–17.CrossRefPubMed
42.
Zurück zum Zitat Eggermont AM et al. Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. The cumulative multicenter European experience. Ann Surg. 1996;224(6):756–64; discussion 764-5.CrossRefPubMedPubMedCentral Eggermont AM et al. Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. The cumulative multicenter European experience. Ann Surg. 1996;224(6):756–64; discussion 764-5.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Grünhagen DJ et al. Technology insight: Utility of TNF-alpha-based isolated limb perfusion to avoid amputation of irresectable tumors of the extremities. Nat Clin Pract Oncol. 2006;3(2):94–103.CrossRefPubMed Grünhagen DJ et al. Technology insight: Utility of TNF-alpha-based isolated limb perfusion to avoid amputation of irresectable tumors of the extremities. Nat Clin Pract Oncol. 2006;3(2):94–103.CrossRefPubMed
44.
Zurück zum Zitat Deroose JP et al. Long-term results of tumor necrosis factor alpha- and melphalan-based isolated limb perfusion in locally advanced extremity soft tissue sarcomas. J Clin Oncol. 2011;29(30):4036–44.CrossRefPubMed Deroose JP et al. Long-term results of tumor necrosis factor alpha- and melphalan-based isolated limb perfusion in locally advanced extremity soft tissue sarcomas. J Clin Oncol. 2011;29(30):4036–44.CrossRefPubMed
Metadaten
Titel
Perioperative Behandlungskonzepte
Therapie von Hochrisiko-Weichteilsarkomen bei Erwachsenen
verfasst von
Gesa Schuebbe
Dorit Di Gioia
Falk Roeder
Hans Roland Dürr
Martin Angele
Rolf Issels
Prof. Dr. med. Lars H. Lindner
Publikationsdatum
09.02.2018
Verlag
Springer Medizin
Erschienen in
InFo Hämatologie + Onkologie / Ausgabe 1/2018
Print ISSN: 2662-1754
Elektronische ISSN: 2662-1762
DOI
https://doi.org/10.1007/s15004-018-5937-3

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