Radiotherapy for Treatment of Adult Soft Tissue Sarcomas
Diagnosis and Treatment of Soft Tissue Tumors: Changes, Challenges and Strategies, Springer International Publishing Ag, ss.117-124, 2025
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2025
- Doi Numarası: 10.1007/978-3-031-77061-6_13
- Yayınevi: Springer International Publishing Ag
- Sayfa Sayıları: ss.117-124
- Anahtar Kelimeler: Adjuvant radiotherapy, Limb-sparing, Preoperative radiotherapy, Radiotherapy, Soft tissue sarcoma
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet
Özet
Soft tissue sarcomas (STS) are rare malignant mesenchymal tumors, less than 1% among the primary malignant tumors, and can occur in any organ or anatomic location of the body (Lahat et al., Surg Clin N Am 88(3):451–481, 2008). The STS are localized most frequently in the lower extremity (46.4%), in order of frequency trunk, retroperitoneal, and upper extremity (Lawrence et al., Ann Surg 205:349–359, 1987). The majority of extremity STS occur in the muscle groups of the extremities so are confined to the muscle compartment. This knowledge is useful for radiation oncologists for defining the compartments at risk. There are many histological subtypes and there have been different behaviors to treatments. About 65% of STS are high grade and 35% are low-grade. On the contrary, the historic belief of radioresistance of STS, high-grade STS have similar radiosensitivity to epithelial neoplasms (Ruka et al., J Surg Oncol 61:290–294, 1996). Previous studies reported radiotherapy (RT) efficacy at limb-sparing surgery, especially for extremity STS (Rosenberg et al. Ann Surg 196(3):305–315, 1982; Lindberg et al. Cancer 47(10):2391–2397, 1981). Assessment of risk factors for local recurrence is complex and incorporates multiple factors. These factors include surgical margin status, grade, tumor size, localization of the tumor, histopathologic subtype, extension of disease, and treatment modality. The curative treatment for localized STS is surgery with negative margins. Chemotherapy (CT) and RT, administered in adjuvant or neoadjuvant settings, have important roles in the multimodal management of STS. Intermediate or high grade, larger size (>5 cm) sarcomas may have a high risk of local recurrence and developing metastases. Furthermore, wide local excision with a 5 cm margin in extremity sarcomas is also associated with a local recurrence rate of 20–25% (Simon and Enneking. J Bone Joint Surg Am 58(3):317–327, 1976; Suit et al. J Clin Oncol 6(5):854–862, 1988; Tran et al. Cancer 70(1):169–177, 1992; Freedman et al., Am J Surg 158(4):367–372, 1989). Regarding these factors, the addition of RT (pre or postoperative) to surgery allows excellent local control with functional limb salvage.