Alektiar K M, Velasco J, Zelefsky M J, Woodruff J M, Lewis J J, Brennan M F
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1051-8. doi: 10.1016/s0360-3016(00)00753-7.
Adjuvant radiotherapy (RT) has been shown to improve local control in patients with soft tissue sarcoma of the extremities (STS). The specific impact of adjuvant radiation on patients with positive margins, however, has not been clearly defined. The purpose of this study was to determine if adjuvant RT improves local control in patients with high-grade STS who had positive margins of resection.
Between 8/82 and 2/97, 110 adult patients with primary high-grade STS of an extremity underwent limb sparing surgery and were found to have a histologically positive microscopic surgical margin. Ninety-one (83%) received RT and 19 (17%) had no RT. The two groups were balanced with regard to size, site, location, and tumor depth. Adjuvant RT was delivered with brachytherapy (BRT) alone in 34 patients, external beam radiotherapy (EBRT) alone in 33 patients, or BRT+EBRT in 24 patients. The BRT dose was 45 Gy when used alone and 15-20 Gy when used as a boost. The EBRT dose was 60-70 Gy when used alone and 45-50 Gy when given with BRT. The median follow-up time was 41 months (range, 3-186 months).
The overall 5 year local control rate was 71%. This rate was significantly higher in the RT group compared to the no RT group (74% vs. 56%, respectively) (p = 0.01). On univariate analysis, lower extremity site and proximal location were also found to be predictors of improved local control (p = 0.03 and 0.03, respectively). However, only proximal location and the use of RT retained their significance as predictors of improved local control on multivariate analysis (p = 0.003 and 0.01, respectively). The overall 5-year distant relapse-free survival, disease-free survival, and overall survival rates were 54%, 44%, and 53%, respectively. No statistical differences were found in these survival rates between RT and no RT groups.
Based on this study, adjuvant radiotherapy seems to improve local control in patients with high-grade STS of the extremity with positive margins. However, local recurrence still occurs in a substantial proportion of patients, mandating further need for improvement.
辅助放疗（RT）已被证明可改善肢体软组织肉瘤（STS）患者的局部控制。然而，辅助放疗对切缘阳性患者的具体影响尚未明确界定。本研究的目的是确定辅助放疗是否能改善切缘阳性的高级别STS患者的局部控制。
在1982年8月至1997年2月期间，110例患有肢体原发性高级别STS的成年患者接受了保肢手术，且组织学检查显示手术切缘为阳性。91例（83%）接受了放疗，19例（17%）未接受放疗。两组在肿瘤大小、部位、位置和深度方面保持平衡。34例患者仅接受近距离放疗（BRT）作为辅助放疗，33例患者仅接受外照射放疗（EBRT），24例患者接受BRT+EBRT。单独使用BRT时剂量为45 Gy，用作增强照射时剂量为15 - 20 Gy。单独使用EBRT时剂量为60 - 70 Gy，与BRT联合使用时剂量为45 - 50 Gy。中位随访时间为41个月（范围3 - 186个月）。
总体5年局部控制率为71%。放疗组的这一比率显著高于未放疗组（分别为74%和56%）（p = 0.01）。单因素分析显示，下肢部位和近端位置也是局部控制改善的预测因素（分别为p = 0.03和0.03）。然而，多因素分析中，只有近端位置和放疗的使用作为局部控制改善的预测因素仍具有显著性（分别为p = 0.003和0.01）。总体5年远处无复发生存率、无病生存率和总生存率分别为54%、44%和53%。放疗组和未放疗组在这些生存率方面未发现统计学差异。
基于本研究，辅助放疗似乎可改善切缘阳性的肢体高级别STS患者的局部控制。然而，相当一部分患者仍会发生局部复发，因此仍需进一步改进。
