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Arthritis und Rheuma 2007; 27(03): 153-161
DOI: 10.1055/s-0037-1619703
Tumororthopädie
Schattauer GmbH

Diagnostik und Therapie von Weichgewebssarkomen im Erwachsenenalter

Diagnostic and therapy of soft tissue sarcomas
Per-Ulf Tunn
1   Klinikfür Chirurgie und Chirurgische Onkologie, Universitätsmedizin Berlin, Charité Campus Buch, Helios Kliniken Berlin
,
Hans Roland Dürr
2   Schwerpunkt Tumororthopädie, Orthopädische Klinik, Klinikum der LMU München, Standort Großhadern
› Author Affiliations
Further Information

Publication History

Publication Date:
24 December 2017 (online)

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Zusammenfassung

Weichteilsarkome sind prinzipiell nur mit einer RO-Resektion im Stadium I-III (UICC) kurativzu therapieren. Dementsprechend sind vor der Therapie das Tumorstadium und insbesondere die korrekte Diagnose sowie das individuelle Risiko der Metastasierung zu erheben. Bereits die Diagnosesicherung stellt ein interdisziplinäres Vorgehen dar. Die Biopsie sollte dort erfolgen, wo auch die logistischen Voraussetzungen der definitiven Therapie gegeben sind. Falsche Schnittführungen und falsche Biopsietechniken können nicht nur zu einer Verzögerung der Therapie, sondern auch zu mutilierenden Eingriffen führen. Ist primär eine R0-Resektion im Stadium I-III zu realisieren, so ist die primäre Chirurgie indiziert. Bei lokal fortgeschrittenen Tumoren, die mutilierende Eingriffe erfordern würden, ist eine neoadjuvante Therapie (z. B. isolierte hypertherme Extremitätenperfusion, Radiotherapie, systemische Chemotherapie) vor der Resektion desTumors zu fordern. Sie verfolgt das Ziel einer lokalen Tumorremission, um nachfolgend günstigere Voraussetzungen für die Tumorresektion und damit für die Lebensqualität zu ermöglichen, da ablative Verfahren die Prognose in der Regel nicht verbessern können. Rekonstruktive Techniken sind unter Ausnutzung multimodaler Konzepte bei etwa 25 % der Patienten indiziert.

Summary

In general, soft tissue sarcomas can be treated curatively onlywith R0 resection in stage I-III (UICC). Accordingly, the tumor stage and in particular the correct diagnosis and the individual risk of metastasis must be ascertained prior to treatment. Even confirming the diagnosis represents an interdisciplinary process. The biopsy should be performed where the logistical requirements for definitive therapy are present. Incorrect incisionsand incorrect biopsy techniques can lead notonlyto a delay in therapy but also to mutilating surgery. The surgical therapy of soft tissue sarcoma in combination with an adjuvant radiation therapy forms the basic treatment of high-grade sarcomas. In locally advanced tumors which failed safe primary R0-resection, however, neoadjuvant concepts (e.g. isolated limb perfusion, radiation therapy, and systemic chemotherapy) should be considered. This has the goal of local tumor remission in order to provide more favorable conditions for the subsequent surgery and thus for quality of life. Reconstructive techniques making use of multimodal concepts are indicated in about 25% of surgical treated patients.

Schlüsselwörter

Weichgewebssarkom - Diagnostik - multimodale Therapie - Chirurgie - Prognose

Keywords

Soft tissue sarcoma - diagnostic - multimodal therapy - surgery - prognosis
 

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