Choong P F, Petersen I A, Nascimento A G, Sim F H
Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Clin Orthop Relat Res. 2001 Jun(387):191-9. doi: 10.1097/00003086-200106000-00026.
Radiotherapy and limb-preserving surgery has replaced amputation and compartmental resection for treatment of soft tissue sarcomas. However, the role of radiotherapy in low-grade tumors remains unclear. This study reviews the outcomes of 132 patients who received multimodality treatment for low-grade soft tissue sarcoma. Large primary tumors (> 5 cm) and the absence of radiotherapy correlated with local recurrence. Radiotherapy was most effective in patients operated on with marginal margins. Patients who were treated with wide surgical margins or had small tumors (< or =5 cm) showed no benefit with adjuvant radiotherapy. Size greater than 5 cm and local recurrence correlated with metastasis. Radiotherapy appears to be important in the management of low-grade soft tissue sarcoma. The principles of local treatment for low-grade soft tissue sarcoma should be the same as for high-grade tumors with a combination of surgery and adjuvant radiotherapy. In a subset of patients with small and widely excised tumors, consideration may be given to withholding radiotherapy. Local recurrence and metastasis from low-grade soft tissue sarcoma may occur as long as 1 decade after primary tumor resection. Long-term review of patients with low-grade tumors may be indicated.
放射治疗和保肢手术已取代截肢和间室切除术用于治疗软组织肉瘤。然而，放射治疗在低级别肿瘤中的作用仍不明确。本研究回顾了132例接受多模式治疗的低级别软组织肉瘤患者的治疗结果。巨大原发性肿瘤（>5 cm）且未接受放射治疗与局部复发相关。放射治疗在手术切缘为边缘性的患者中最为有效。接受广泛手术切缘治疗或肿瘤较小（≤5 cm）的患者未从辅助性放射治疗中获益。肿瘤大小大于5 cm和局部复发与转移相关。放射治疗在低级别软组织肉瘤的治疗中似乎很重要。低级别软组织肉瘤的局部治疗原则应与高级别肿瘤相同，采用手术和辅助性放射治疗相结合的方法。对于一部分肿瘤较小且切除范围广泛的患者，可考虑不进行放射治疗。低级别软组织肉瘤的局部复发和转移可能在原发性肿瘤切除后长达10年才会出现。可能需要对低级别肿瘤患者进行长期随访。
