软组织肉瘤的放射治疗：临床实践及进展

软组织肉瘤的治疗策略取决于肿瘤的病理学类型、组织分化及发病部位。放射治疗是软组织肉瘤的重要治疗手段之一。四肢软组织肉瘤经局部扩大切除后继以放射治疗可达到与截肢术同等的长期生存率,且可部分保存肢体功能;腹膜后肉瘤术前放射治疗可降低肿瘤局部复发的风险;头颈部软组织肉瘤通常因肿瘤无法完全切除而需接受术后或根治性放射治疗。采用术前放射治疗可获得与术后辅助放疗相似的局部控制和长期生存率,但显著降低了放疗相关的远期不良反应。放疗或联合放化疗可缩小肿瘤体积,将部分无法手术切除的病例转化为可手术切除。此外,放射治疗也是无法进行或拒绝手术的软组织肉瘤患者的主要局部治疗手段。放射治疗新技术,如质子重离子射线放疗,因其较高的精确性及生物有效性,不仅可显著降低正常组织的治疗相关损伤风险,还可提高肿瘤尤其是放射敏感性较差的肿瘤的局部控制率。对于外照射治疗后复发或放射诱导的继发性软组织肿瘤,质子重离子射线治疗可作为重要的挽救性治疗手段。

Radiotherapy for soft-tissue sarcoma:clinical practice and progress

he treatment strategies for soft-tissue sarcoma (STS) largely depend on the histological subtype, differentiation, and the origin of the disease. Radiotherapy is an important component of the multi-modality management for STS. For STS of the extremities, surgery followed by adjuvant radiotherapy can produce identical disease control and overall survival rates as compared to amputation, but ensures function preservation. Pre-operative radiotherapy improves disease control for retroperitoneal STS. Adjuvant or definitive radiation therapy is a vital component for STS of the head and neck region. Pre-operative radiotherapy, as compared to post-operative radiation, produces similar disease control rates yet reduces late treatment-induced toxicities. Furthermore, radiotherapy is the mainstay treatment modality for inoperable or unresectable STS. Novel radiotherapy technology such as particle beam radiation therapy (PBRT) can not only reduce radiation-induced toxicities but also improve disease control especially for radioresistant subtypes, due to its high precision and improved biological effectiveness. PBRT is also a potentially effective option for salvaging STS patients who failed previous course of radiotherapy, or for patients diagnosed with radiation-induced secondary primary STS