Ballo Matthew T, Zagars Gunar K, Cormier Janice N, Hunt Kelly K, Feig Barry W, Patel Shreyaskumar R, Pisters Peter W T
Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1461-7. doi: 10.1016/j.ijrobp.2003.09.079.
To evaluate the clinical significance of the interval between surgery and postoperative radiotherapy (RT) for patients with soft tissue sarcoma.
The records of 799 patients who underwent postoperative RT for soft tissue sarcoma between 1960 and 2000 were retrospectively reviewed. Univariate and multivariate analyses were used to evaluate the potential impact of the timing of postoperative RT on the rate of local control (LC).
The actuarial overall LC rate was 79% at 10 years and 78% at 15 years. Univariate analysis indicated that the factors associated with an inferior 10-year LC rate were positive resection margins (p <0.0001); treatment for recurrent disease (p <0.0001); primary location in the head and neck or deep trunk (p <0.0001); age >64 years (p <0.0001); histopathologic subtype of malignant fibrous histiocytoma, neurogenic sarcoma, or epithelioid sarcoma (p = 0.01); tumor size >10 cm (p = 0.02); postoperative radiation dose <64 Gy (p = 0.03); and high histologic grade (p = 0.05). On multivariate analysis, all these factors remained statistically significant, except for high histologic grade and large size. A delay between surgery and the start of RT of >30 days was associated with a decreased 10-year LC rate, but this association was not statistically significant (76% vs. 83%, p = 0.07). The potential association between RT delay and inferior LC could be explained by an imbalance in the distribution of other prognostic factors.
The interval between surgery and RT did not significantly impact the 10-year LC rate. These findings indicate that an RT delay should not be viewed as an independent adverse factor for LC and that treatment intensification may not be necessary for patients in whom a treatment delay has already occurred.
评估软组织肉瘤患者手术与术后放疗（RT）间隔时间的临床意义。
回顾性分析1960年至2000年间接受软组织肉瘤术后放疗的799例患者的记录。采用单因素和多因素分析评估术后放疗时间对局部控制率（LC）的潜在影响。
10年时精算总LC率为79%，15年时为78%。单因素分析表明，与10年LC率较低相关的因素包括手术切缘阳性（p<0.0001）；复发性疾病的治疗（p<0.0001）；原发部位在头颈部或深部躯干（p<0.0001）；年龄>64岁（p<0.0001）；恶性纤维组织细胞瘤、神经源性肉瘤或上皮样肉瘤的组织病理学亚型（p=0.01）；肿瘤大小>10 cm（p=0.02）；术后放疗剂量<64 Gy（p=0.03）；以及高组织学分级（p=0.05）。多因素分析显示，除高组织学分级和肿瘤大小外，所有这些因素仍具有统计学意义。手术与RT开始之间延迟>30天与10年LC率降低相关，但这种关联无统计学意义（76%对83%，p=0.07）。RT延迟与LC较差之间的潜在关联可通过其他预后因素分布的不平衡来解释。
手术与RT之间的间隔时间对10年LC率无显著影响。这些发现表明，不应将RT延迟视为LC的独立不利因素，对于已经出现治疗延迟的患者，可能无需强化治疗。
