Schuck Andreas, Mattke Adrian C, Schmidt Bernhard, Kunz Denise S, Harms Dieter, Knietig Robert, Treuner Joern, Koscielniak Ewa
Radiotherapy Department, University Hospital, A. Schweitzer Strasse 33, D-48129 Muenster, Germany.
J Clin Oncol. 2004 Jan 1;22(1):143-9. doi: 10.1200/JCO.2004.04.180.
In the prospective Cooperative Soft Tissue Sarcoma Study Group (CWS) 81, 86, 91, and 96 trials, radiotherapy was omitted in some patients with rhabdomyosarcoma and rhabdomyosarcoma-like tumors within Intergroup Rhabdomyosarcoma Study (IRS) group II. This analysis evaluates whether subgroups can be defined for which radiotherapy is not necessary.
Two hundred three patients who were registered between January 1981 and December 1998 were eligible for evaluation. Radiotherapy was given depending on tumor location, histology, and whether a secondary complete resection could be performed. The recommended radiation doses ranged from 32 to 54 Gy.
One hundred ten patients did receive and 93 patients did not receive radiotherapy. The calculated local control after 5 years was 83% with and 65% without radiotherapy (P <.004). Event-free survival (EFS) at 5 years was 76% and 58%, respectively (P <.005). Overall survival (OS) at 5 years was 84% and 77% (P = not significant). The differences in local control were significant for the subgroups of irradiated patients with favorable histology, favorable site, and initial tumor size of less than 5 cm. A trend for improved local control with irradiation was observed for patients with unfavorable site, unfavorable histology, and large primary tumors. EFS was significantly improved for irradiated patients who had unfavorable histology, both favorable and unfavorable tumor sites, and small initial tumors. OS was significantly improved for patients with unfavorable histology through radiation.
Local control and EFS in group II patients are improved with radiotherapy. No subgroup could be defined for which the omission of radiotherapy produced outcome equivalent to that of patients who were irradiated.
在前瞻性合作软组织肉瘤研究组（CWS）81、86、91和96试验中，横纹肌肉瘤和横纹肌肉瘤样肿瘤患者在横纹肌肉瘤协作组（IRS）II组内的部分患者未接受放疗。本分析评估是否可定义出无需放疗的亚组。
1981年1月至1998年12月登记的203例患者符合评估条件。根据肿瘤位置、组织学类型以及是否能进行二次根治性切除给予放疗。推荐的放疗剂量范围为32至54 Gy。
110例患者接受了放疗，93例患者未接受放疗。计算得出5年后接受放疗患者的局部控制率为83%，未接受放疗患者为65%（P <.004）。5年无事件生存率（EFS）分别为76%和58%（P <.005）。5年总生存率（OS）分别为84%和77%（P = 无显著性差异）。对于组织学类型良好、部位良好且初始肿瘤大小小于5 cm的接受放疗患者亚组，局部控制差异显著。对于部位不佳、组织学类型不佳和原发肿瘤较大的患者，观察到放疗可改善局部控制的趋势。对于组织学类型不佳、肿瘤部位良好和不佳以及初始肿瘤较小的接受放疗患者，EFS显著改善。通过放疗，组织学类型不佳患者的OS显著改善。
放疗可改善II组患者的局部控制和EFS。无法定义出省略放疗后结局与接受放疗患者相当的亚组。
