Micke Oliver, Seegenschmiedt M Heinrich
Department of Radiotherapy, Münster University Hospital, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
Int J Radiat Oncol Biol Phys. 2005 Mar 1;61(3):882-91. doi: 10.1016/j.ijrobp.2004.07.705.
After a general Patterns of Care Study (PCS) the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) initiated a multicenter cohort study to analyze the radiation therapy practice for aggressive fibromatosis.
In 2002 a PCS was conducted in all German radiotherapy (RT) institutions by mailing a standardized structured questionnaire, to assess patients accrual, number, pretreatment, treatment indications, RT, and target volume concepts for irradiation in aggressive fibromatosis. In addition, the treatment outcome of individual patients was evaluated. The PCS was structured and analyzed according to the model for quality assessment by Donabedian in three major components: structure, process, and outcome evaluation.
A total of 101 institutions returned the questionnaire: 52.7% reported satisfactory clinical data and experience for inclusion in this analysis. A total accrual rate of 278 patients per year was reported with median number of 2 cases (1-7 cases) per institution. Satisfactory data for a long-term clinical evaluation was reported for 345 patients from 19 different institutions. The applied total doses ranged between 36 and 65 Gy (median, 60 Gy). The local control rate was 81.4% in primary RT for unresectable tumors and 79.6% in postoperative RT. No acute or late radiation toxicities > Grade 2 (RTOG) were observed. No clear dose-response relationship could be established, but there was a tendency toward a lower local control rate in patients with a higher number of operative procedures before RT and patients treated for recurrent aggressive fibromatosis.
This study comprises the largest database of cases reported for RT in aggressive fibromatosis. Radiotherapy provides a high local control rate in the postoperative setting and in unresectable tumors. This PCS may serve as a starting point for a national or international prospective multicenter study or registry, or both.
在一项总体的癌症照护模式研究（PCS）之后，德国良性疾病放射治疗合作组（GCG-BD）启动了一项多中心队列研究，以分析侵袭性纤维瘤病的放射治疗实践。
2002年，通过邮寄标准化结构化问卷对德国所有放射治疗（RT）机构进行了PCS，以评估侵袭性纤维瘤病患者的入组情况、数量、预处理、治疗指征、放疗及照射靶区概念。此外，还评估了个体患者的治疗结果。PCS按照Donabedian的质量评估模型分为三个主要部分进行构建和分析：结构、过程和结果评估。
共有101家机构返回了问卷：52.7%报告有纳入本分析的满意临床数据和经验。报告的每年总入组率为278例患者，每个机构的中位数为2例（1 - 7例）。来自19个不同机构的345例患者报告了可用于长期临床评估的满意数据。应用的总剂量范围在36至65 Gy之间（中位数为60 Gy）。不可切除肿瘤的初次放疗局部控制率为81.4%，术后放疗为79.6%。未观察到大于2级（RTOG）的急性或晚期放射毒性。未能建立明确的剂量反应关系，但放疗前手术操作次数较多的患者以及复发性侵袭性纤维瘤病患者的局部控制率有降低趋势。
本研究包含了侵袭性纤维瘤病放射治疗报告病例的最大数据库。放射治疗在术后及不可切除肿瘤中提供了较高的局部控制率。该PCS可作为国家或国际前瞻性多中心研究或登记处（或两者）的起点。
