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四肢软组织肉瘤的辅助化疗与新辅助化疗

Author
Robert Maki, MD, PhD
Section Editor
Thomas F DeLaney, MD
Deputy Editor
Diane MF Savarese, MD
Translators
翟墨, 主治医师

引言

软组织肉瘤(soft tissue sarcoma, STS)是一种起源于骨外结缔组织(包括周围神经系统)的少见的恶性肿瘤。其可出现于身体的任何部位，但在四肢最常见，尤其是下肢。 (参见“软组织肉瘤的临床表现、组织病理学、诊断性评估及分期”，关于‘临床表现’一节)

在四肢STS的治疗中，主要的治疗目标是使患者长期存活、避免局部复发、最大化保留功能，以及使并发症最小化。外科切除术是潜在治愈性治疗的基石。对于几乎所有肢体肉瘤大于5cm的患者，治疗中加入放疗(radiation therapy, RT)可改善局部控制，且还对保肢有重要作用。术前(新辅助)放疗较术后(辅助)放疗更具优势，联合使用放疗和化疗的新辅助治疗也具优势，尤其是对于复发性的和大的高级别原发性肿瘤。这些专题将在别处详细讨论。 (参见“肢体和胸壁原发性软组织肉瘤的局部治疗”和“局部复发和不能切除的局部晚期四肢软组织肉瘤的治疗”)

对于数种主要发生于儿童的肉瘤(例如，横纹肌肉瘤、尤文肉瘤和骨源性肉瘤)，全身化疗是治疗的常规部分。然而，辅助化疗在进行成人型局限性肢体STS(例如，平滑肌肉瘤、脂肪肉瘤、滑膜肉瘤)切除术的患者中的价值仍存在争议，因为所涉及的诊断类型复杂性。

本专题将讨论在成人型四肢STS的治疗中辅助和新辅助化疗的使用。化疗在腹膜后STS、横纹肌肉瘤和尤文肉瘤家族肿瘤治疗中的作用，以及新辅助联合形式疗法来治疗大的高级别或复发性四肢STS将在别处详细讨论。 (参见“腹膜后软组织肉瘤的临床特征、评估及治疗”，关于‘辅助化疗’一节和“儿童、青少年及成人横纹肌肉瘤的治疗治疗”和“尤文肉瘤家族肿瘤的治疗”和“转移性软组织肉瘤的外科治疗及其他局部治疗”)

辅助化疗

儿科型肉瘤 — 局部治疗中加用全身化疗可显著改善常见儿科型肉瘤(横纹肌肉瘤、骨源性肉瘤以及软组织和骨均包括在内的尤文肉瘤家族肿瘤)的结局。大部分现代治疗方案中使用了初始(诱导或新辅助)化疗，之后采取局部治疗和附加(辅助)化疗。

                

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-13.
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