Soft tissue sarcoma sometimes includes small satellite nodules in addition to the reaction area of the pseudo-envelope. In addition, sometimes the exact extent of tumor infiltration cannot be observed by the naked eye, and although surgery is performed according to the standardized ? operation, but due to the above factors and anatomical constraints, it is impossible to achieve true three-dimensional resection in certain large blood vessels, major nerves, and skeletal areas, so after extensive resection, there are still 10-30% of cases with recurrence, which requires further radiotherapy after the most standardized surgery possible.
Avoiding and reducing future recurrence and how to reduce the recurrence rate has been a research topic for oncologists. At present, intraoperative and postoperative irradiation can already achieve the purpose of reducing recurrence, but the standardization of surgical resection is more important.
The common chemotherapy regimen for soft tissue sarcoma has been widely studied in clinical practice. Multi-drug combination chemotherapy can achieve better outcomes than single-drug chemotherapy, with some achieving complete remission, improved median remission, disease-free survival and overall survival counties. The specific chemotherapy regimens commonly used clinically are as follows.
ADM+DTIC combination: efficiency up to 40%
ADM25-70mg/m2 intravenous drip on day 1
DTIC200-400mg/m2 intravenous drip day 1-3 or day 5 repeated every 3 weeks.
ADM+lFO+DTIC+MESNA regimen: It is a more reported combination chemotherapy regimen in the 1990s. The efficacy rate is 32%-57%
ADM60mg/m2 IV drip on day 1
IF01.2-2.5∥mz intravenous drip day 1-5
DTIC200mg/m2 intravenous drip day 1-3 repeated every 3 weeks
This force case is added more GM-CSF or G-CSF to reduce the bone marrow suppression caused by increasing intensity.
CTX+VCR+ADM+DTIC regimen.
CTX400-500mg/m2, IV drip, day 1
VCRl-1.5mg/m2 intravenously on days 1 and 5
ADM50mg/m2 or EADM50mg/m2, intravenous, day 1
DTIC200-400mg/mz, IV drip, days 1-3 or 1-5 Repeat every 3-4 weeks
Other chemotherapy modalities: In the mid-1990s, a combination regimen of adriamycin and isocyclophosphamide was reported in neoadjuvant chemotherapy with an efficiency of 60%-70%. If 3 courses of neoadjuvant chemotherapy can be applied preoperatively, followed by radiation therapy, and postoperative adjuvant chemotherapy is given after surgical resection, the results improve disease-free survival and long-term survival.
Postoperative adjuvant chemotherapy has been reported in the 1990s by the NCI, MD, Anderson Distemper Center, Mayoclinic, and the EORTC group protocols in Europe, all showing improved disease-free survival and delayed distant metastases, but overall survival rates have been reported inconsistently. According to the CTX:HRANE Data Center in 2000, a systematic analysis of 14 clinical trials noted that excluding other interfering factors
chemotherapy was effective in improving disease-free survival, overall survival, and control of recurrence and metastasis after excluding other interfering factors. Although the statistical significance was not significant, the clinical effect was generally positive. Therefore, for some highly malignant sarcomas, standardized chemotherapy regimens are still used. The future progress of chemotherapy for soft tissue sarcoma depends on the development and application of new chemical drugs. In addition to interventional chemotherapy, warming and perfusion measures can also improve drug concentration and efficacy.
In some cases, the pathological examination of the tumor after treatment shows complete necrosis, which indicates that the effect of chemotherapy is certain. Recent studies have shown that induction chemotherapy has become a new mode of sarcoma treatment, and radiotherapy is not advocated in many cases with negative surgical margins after induction chemotherapy. The position of chemotherapy in future comprehensive treatment will be further strengthened.