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Handchirurgie Scan 2015; 04(03): 207-219
DOI: 10.1055/s-0034-1392716
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© Georg Thieme Verlag KG Stuttgart · New York

Die Therapie von Weichteilsarkomen an Hand und Unterarm

Kai Megerle
,
Michael Sauerbier
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Publication History

Publication Date:
11 September 2015 (online)

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Zusammenfassung

Weichteilsarkome sind seltene maligne Tumoren, die bevorzugt an den Extremitäten auftreten. Wichtigstes chirurgisches Therapieprinzip zur lokalen Tumorkontrolle ist die Resektion im Gesunden, Voraussetzung einer dauerhaft erfolgreichen Therapie ist jedoch darüber hinaus die enge Zusammenarbeit aller involvierten Fachdisziplinen. Für den behandelnden Operateur ist daher neben dem Beherrschen der chirurgischen Techniken auch ein grundlegendes Verständnis der nicht-chirurgischen Therapieansätze wichtig. Der vorliegende Artikel fasst nicht nur die chirurgischen Therapieprinzipien zusammen, sondern gibt auch einen Überblick über wichtige Aspekte der interdisziplinären Therapieplanung.

 

  • Literatur

  • 1 Lawrence WJ, Donegan WL, Natarajan N et al. Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg 1987; 205: 349-359
    CrossrefGoogle Scholar
  • 2 Jemal A, Siegel R, Xu J et al. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277-300
    CrossrefPubMedGoogle Scholar
  • 3 Levy A, Le Pechoux C, Terrier P et al. Epithelioid sarcoma: need for a multimodal approach to maximize the chances of curative conservative treatment. Ann Surg Oncol 2014; 21: 269-276
    CrossrefGoogle Scholar
  • 4 Kim JH, Chu FC, Woodard HQ et al. Radiation-induced soft-tissue and bone sarcoma. Radiology 1978; 129: 501-508
    Google Scholar
  • 5 Wingren G, Fredrikson M, Brage HN et al. Soft tissue sarcoma and occupational exposures. Cancer 1990; 66: 806-811
    CrossrefGoogle Scholar
  • 6 Sinha S, Peach AH. Diagnosis and management of soft tissue sarcoma. BMJ 2010; 341: c7170
    CrossrefGoogle Scholar
  • 7 Noria S, Davis A, Kandel R et al. Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg Am 1996; 78: 650-655
    Google Scholar
  • 8 Rehders A, Stoecklein NH, Poremba C et al. Reexcision of soft tissue sarcoma: sufficient local control but increased rate of metastasis. World J Surg 2009; 33: 2599-2605
    CrossrefGoogle Scholar
  • 9 Dimitrakopoulou-Strauss A, Strauss LG, Schwarzbach M et al. Dynamic PET 18F-FDG studies in patients with primary and recurrent soft-tissue sarcomas: impact on diagnosis and correlation with grading. J Nucl Med 2001; 42: 713-720
    Google Scholar
  • 10 Lehnhardt M, Daigeler A, Hauser J et al. The value of expert second opinion in diagnosis of soft tissue sarcomas. J Surg Oncol 2008; 97: 40-43
    CrossrefGoogle Scholar
  • 11 Strauss DC, Qureshi YA, Hayes AJ et al. The role of core needle biopsy in the diagnosis of suspected soft tissue tumours. J Surg Oncol 2010; 102: 523-529
    CrossrefGoogle Scholar
  • 12 Verheijen P, Witjes H, van Gorp J et al. Current pathology work-up of extremity soft tissue sarcomas, evaluation of the validity of different techniques. Eur J Surg Oncol 2010; 36: 95-99
    CrossrefGoogle Scholar
  • 13 Tunn PU, Gebauer B, Fritzmann J et al. Weichteilsarkome. Chirurg 2004; 75: 1165-1173
    CrossrefGoogle Scholar
  • 14 AJCC Cancer Staging Manual. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Hrsg. 7.. Aufl. New York: Springer-Verlag; 2010. ISBN: 978-0-387-88440-0
    Google Scholar
  • 15 Fong Y, Coit DG, Woodruff JM et al. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993; 217: 72-77
    CrossrefPubMedGoogle Scholar
  • 16 Tunn PU, Andreou D, Illing H et al. Sentinel node biopsy in synovial sarcoma. Eur J Surg Oncol 2008; 34: 704-707
    CrossrefGoogle Scholar
  • 17 Maduekwe UN, Hornicek FJ, Springfield DS et al. Role of sentinel lymph node biopsy in the staging of synovial, epithelioid, and clear cell sarcomas. Ann Surg Oncol 2009; 16: 1356-1363
    CrossrefGoogle Scholar
  • 18 Brien EW, Terek RM, Geer RJ et al. Treatment of soft-tissue sarcomas of the hand. J Bone Joint Surg Am 1995; 77: 564-571
    Google Scholar
  • 19 Tanabe KK, Pollock RE, Ellis LM et al. Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer 1994; 73: 1652-1659
    CrossrefGoogle Scholar
  • 20 Dickinson IC, Whitwell DJ, Battistuta D et al. Surgical margin and its influence on survival in soft tissue sarcoma. ANZ J Surg 2006; 76: 104-109
    CrossrefGoogle Scholar
  • 21 Tunn PU, Kettelhack C, Durr HR. Standardized approach to the treatment of adult soft tissue sarcoma of the extremities. Recent Results Cancer Res 2009; 179: 211-228
    Google Scholar
  • 22 Megerle K, Sauerbier M. Reconstructive treatment of soft tissue sarcoma of the upper extremity. J Hand Surg Am 2011; 36: 1241-1247
    CrossrefPubMedGoogle Scholar
  • 23 Sadoski C, Suit HD, Rosenberg A et al. Preoperative radiation, surgical margins, and local control of extremity sarcomas of soft tissues. J Surg Oncol 1993; 52: 223-230
    CrossrefGoogle Scholar
  • 24 Lehnhardt M, Hirche C, Daigeler A et al. Weichgewebssarkome der oberen Extremität. Analyse prognoserelevanter Faktoren bei 160 Patienten. Chirurg 2012; 83: 143-152
    CrossrefGoogle Scholar
  • 25 Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980; 153: 106-120
    Google Scholar
  • 26 Gerrand CH, Wunder JS, Kandel RA et al. Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence. J Bone Joint Surg Br 2001; 83: 1149-1155
    CrossrefGoogle Scholar
  • 27 Clarkson PW, Griffin AM, Catton CN et al. Epineural dissection is a safe technique that facilitates limb salvage surgery. Clin Orthop Relat Res 2005; 438: 92-96
    Google Scholar
  • 28 Kemp MA, Hinsley DE, Gwilym SE et al. Functional and oncological outcome following marginal excision of well-differentiated forearm liposarcoma with nerve involvement. J Hand Surg Am 2011; 36: 94-100
    CrossrefGoogle Scholar
  • 29 Manoso MW, Frassica DA, Deune EG et al. Outcomes of re-excision after unplanned excisions of soft-tissue sarcomas. J Surg Oncol 2005; 91: 153-158
    CrossrefGoogle Scholar
  • 30 Kepka L, Suit HD, Goldberg SI et al. Results of radiation therapy performed after unplanned surgery (without re-excision) for soft tissue sarcomas. J Surg Oncol 2005; 92: 39-45
    CrossrefGoogle Scholar
  • 31 Trabulsi NH, Patakfalvi L, Nassif MO et al. Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials. J Surg Oncol 2012; 106: 921-928
    CrossrefGoogle Scholar
  • 32 Deroose JP, Eggermont AM, van Geel AN 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: 4036-4044
    CrossrefGoogle Scholar
  • 33 Olofsson R, Bergh P, Berlin O et al. Long-term outcome of isolated limb perfusion in advanced soft tissue sarcoma of the extremity. Ann Surg Oncol 2012; 19: 1800-1807
    CrossrefGoogle Scholar
  • 34 Vetter M, Germann G, Bickert B et al. Current strategies for sarcoma reconstruction at the forearm and hand. J Reconstr Microsurg 2010; 26: 455-460
    Article in Thieme ConnectGoogle Scholar
  • 35 Davis AM, O'Sullivan B, Turcotte R et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol 2005; 75: 48-53
    CrossrefPubMedGoogle Scholar
  • 36 Bruner S, Bickert B, Sauerbier M et al. Concept of arteriovenous loupes in high-risk free-tissue transfer: history and clinical experiences. Microsurgery 2004; 24: 104-113
    CrossrefGoogle Scholar
  • 37 Sauerbier M, Giessler GA, Germann G et al. Einsatzmöglichkeiten des freien lateralen Oberarmlappens zur Defektdeckung an Hand und Unterarm. Unfallchirurg 2010; 113: 821-831
    CrossrefGoogle Scholar
  • 38 Gohla T, Kehrer A, Holle G et al. Funktionelle und ästhetische Gesichtspunkte bei der Defektdeckung der Streckseite an Hand und distalem Unterarm mit freien Lappenplastiken. Unfallchirurg 2007; 110: 5-13
    CrossrefGoogle Scholar
  • 39 Kremer T, Bickert B, Germann G et al. Outcome assessment after reconstruction of complex defects of the forearm and hand with osteocutaneous free flaps. Plast Reconstr Surg 2006; 118: 443-454; discussion 455-456
    CrossrefPubMedGoogle Scholar
  • 40 Ghert MA, Davis AM, Griffin AM et al. The surgical and functional outcome of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma of the extremity. Ann Surg Oncol 2005; 12: 1102-1110
    CrossrefGoogle Scholar
  • 41 Meek MF, Coert JH, Robinson PH. Poor results after nerve grafting in the upper extremity: Quo vadis?. Microsurgery 2005; 25: 396-402
    CrossrefGoogle Scholar
  • 42 Lundborg G, Rosen B. Sensory relearning after nerve repair. Lancet 2001; 358: 809-810
    CrossrefPubMedGoogle Scholar
  • 43 Brown JM, Mackinnon SE. Nerve transfers in the forearm and hand. Hand Clin 2008; 24: 319-340
    CrossrefGoogle Scholar
  • 44 Ottaviani G, Robert RS, Huh WW et al. Functional, psychosocial and professional outcomes in long-term survivors of lower-extremity osteosarcomas: amputation versus limb salvage. Cancer Treat Res 2009; 152: 421-436
    Google Scholar
  • 45 Küntscher MV, Erdmann D, Strametz S et al. Die Filetlappenplastik zur Rekonstruktion ausgedehnter Defekte der oberen Extremität einschließlich Schulterregion. Chirurg 2002; 73: 1019-1024
    CrossrefGoogle Scholar
  • 46 Hahn SB, Choi YR, Kang HJ et al. Segmental resection and replantation have a role for selected advanced sarcomas in the upper limb. Clin Orthop Relat Res 2009; 467: 2918-2924
    CrossrefGoogle Scholar
  • 47 Ver Halen JP, Yu P, Skoracki RJ et al. Reconstruction of massive oncologic defects using free fillet flaps. Plast Reconstr Surg 2010; 125: 913-922
    CrossrefGoogle Scholar
  • 48 LeVay J, O'Sullivan B, Catton C et al. Outcome and prognostic factors in soft tissue sarcoma in the adult. Int J Radiat Oncol Biol Phys 1993; 27: 1091-1099
    CrossrefGoogle Scholar
  • 49 Zagars GK, Ballo MT, Pisters PW et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer 2003; 97: 2530-2543
    CrossrefPubMedGoogle Scholar
  • 50 Pisters PW, Leung DH, Woodruff J et al. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996; 14: 1679-1689
    CrossrefPubMedGoogle Scholar
  • 51 Canter RJ, Beal S, Borys D et al. Interaction of histologic subtype and histologic grade in predicting survival for soft-tissue sarcomas. J Am Coll Surg 2010; 210: 191-198.e2
    CrossrefGoogle Scholar
  • 52 Khatri VP, Goodnight JEJ. Extremity soft tissue sarcoma: controversial management issues. Surg Oncol 2005; 14: 1-9
    CrossrefGoogle Scholar
  • 53 Mankin HJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am 1996; 78: 656-663
    Google Scholar
  • 54 Gustafson P, Dreinhofer KE, Rydholm A. Soft tissue sarcoma should be treated at a tumor center. A comparison of quality of surgery in 375 patients. Acta Orthop Scand 1994; 65: 47-50
    CrossrefGoogle Scholar