Jelinek J A, Stelzer K J, Conrad E, Bruckner J, Kliot M, Koh W, Laramore G E
University of Washington School of Medicine, Seattle, WA, USA.
Int J Radiat Oncol Biol Phys. 2001 May 1;50(1):121-5. doi: 10.1016/s0360-3016(00)01570-4.
The purpose of this study was to determine if radiotherapy is a beneficial adjuvant treatment after desmoid tumor resection.
A retrospective analysis was performed on 54 patients who underwent surgery without prior radiation at our institution between 1982 and 1998 to remove a desmoid tumor. Thirty-five patients had adjuvant radiation therapy after surgery, and 19 patients had surgery alone without immediate postoperative radiation. Sixteen of the 35 patients who underwent immediate postoperative radiation treatment had at least one prior resection before reoperation at our institution. Recurrence was defined as radiographic increase in tumor size after treatment. Follow-up interval (mean 39 months) and duration of local control were measured from the date of surgery at our institution. Potential prognostic factors for time to tumor progression were analyzed.
Adjuvant treatment with radiation was the only significant prognostic factor for local control. The five-year actuarial local control rate was 81% for the 35 patients who underwent radiation in addition to surgery, compared to 53% for the 19 patients who underwent surgery alone (p = 0.018). For the patients who did not receive adjuvant radiation, only younger age at the time of surgery was associated with increased risk of failure (p = 0.035). Gross or microscopic margin status and number of prior operations were not detected as prognostic for local failure. For patients who did receive postoperative radiation, only abdominal location was associated with increased risk of failure (p = 0.0097).
Radiation treatment as an adjuvant to surgery improved local control over surgery alone. Multiple operations before adjuvant radiation did not decrease the probability of subsequent tumor control. Radiation should be considered as adjuvant therapy to surgery if repeated surgery for a recurrent tumor would be complicated by a significant risk of morbidity.
本研究旨在确定放疗是否为韧带样瘤切除术后有益的辅助治疗方法。
对1982年至1998年间在我院接受手术切除韧带样瘤且术前未接受放疗的54例患者进行回顾性分析。35例患者术后接受辅助放疗，19例患者仅接受手术，术后未立即放疗。35例术后立即接受放疗的患者中，有16例在我院再次手术前至少有过一次先前切除史。复发定义为治疗后肿瘤大小的影像学增加。随访间隔（平均39个月）和局部控制持续时间从我院手术日期开始计算。分析了肿瘤进展时间的潜在预后因素。
放疗辅助治疗是局部控制的唯一显著预后因素。35例接受手术加放疗的患者五年精算局部控制率为81%，而19例仅接受手术的患者为53%（p = 0.018）。对于未接受辅助放疗的患者，仅手术时年龄较小与失败风险增加相关（p = 0.035）。大体或显微镜下切缘状态及先前手术次数未被检测为局部失败的预后因素。对于接受术后放疗的患者，仅腹部位置与失败风险增加相关（p = 0.0097）。
放疗作为手术的辅助治疗比单纯手术改善了局部控制。辅助放疗前的多次手术并未降低后续肿瘤控制的概率。如果复发性肿瘤再次手术会伴有显著的发病风险，则应考虑将放疗作为手术的辅助治疗。
