Alektiar Kaled M, Leung Dennis, Zelefsky Michael J, Brennan Murray F
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 2002 Mar 15;20(6):1643-50. doi: 10.1200/JCO.2002.20.6.1643.
Adjuvant radiation therapy (RT) has been shown to improve local control in patients with high-grade soft tissue sarcoma (STS) of the extremity. This study sought to define the optimal management in patients with stage II-B (high-grade, size < or = 5 cm) tumors.
Between July 1982 and December 1998, 204 adult patients with primary stage II-B STS underwent limb-sparing surgery with negative microscopic margins. Eighty-eight patients (43%) received RT; 116 (57%) did not. The RT and no-RT groups were balanced with regard to age, site (upper v lower extremity), whether patients had prior unplanned excision, and location (central, i.e., shoulder/groin v non-central). The RT group had more deep tumors (P =.03). Adjuvant RT was delivered with brachytherapy in 60% and external-beam radiation in 40% of patients.
With a median follow-up of 67 months, the 5-year local control, distant relapse-free survival, and disease-specific survival rates were 82%, 80%, and 88%, respectively. There was no significant difference in local control between the RT and no-RT groups (84% v 80%, respectively, P =.3). Tumor depth, site, and prior unplanned excision did not correlate with local control. The only independent predictors of poor local control were central tumor location (relative risk [RR] = 3; 95% confidence interval [CI], 2 to 7; P =.005) and age more than 50 years (RR = 6; 95% CI, 2 to 13; P =.001).
In this retrospective study, adjuvant RT did not significantly improve local control in patients with stage II-B STS of the extremity. The outcome of patients with central tumor location was poor, and efforts to identify the optimal local treatment approach for such patients are warranted.
辅助性放射治疗（RT）已被证明可改善肢体高级别软组织肉瘤（STS）患者的局部控制情况。本研究旨在确定II - B期（高级别，大小≤5 cm）肿瘤患者的最佳治疗方案。
1982年7月至1998年12月期间，204例成年II - B期原发性STS患者接受了保肢手术，切缘显微镜下阴性。88例患者（43%）接受了RT；116例（57%）未接受。RT组和非RT组在年龄、部位（上肢与下肢）、患者是否曾有计划外切除以及位置（中央，即肩部/腹股沟与非中央）方面保持平衡。RT组深部肿瘤更多（P = 0.03）。60%的患者采用近距离放射治疗进行辅助RT，40%的患者采用外照射放疗。
中位随访67个月，5年局部控制率、远处无复发生存率和疾病特异性生存率分别为82%、80%和88%。RT组和非RT组的局部控制率无显著差异（分别为84%和80%，P = 0.3）。肿瘤深度、部位和既往计划外切除与局部控制无关。局部控制不佳的唯一独立预测因素是肿瘤位于中央（相对风险[RR]=3；95%置信区间[CI]，2至7；P = 0.005）和年龄超过50岁（RR = 6；95% CI，2至13；P = 0.001）。
在这项回顾性研究中，辅助RT并未显著改善肢体II - B期STS患者的局部控制情况。肿瘤位于中央的患者预后较差，因此有必要努力确定此类患者的最佳局部治疗方法。
