Davis Aileen M, O'Sullivan Brian, Turcotte Robert, Bell Robert, Catton Charles, Chabot Pierre, Wunder Jay, Hammond Alex, Benk Veronique, Kandel Rita, Goddard Karen, Freeman Carolyn, Sadura Anna, Zee Benny, Day Andrew, Tu Dongsheng, Pater Joseph
Toronto Rehabilitation Institute, Ont. M5G 2A2, Canada.
Radiother Oncol. 2005 Apr;75(1):48-53. doi: 10.1016/j.radonc.2004.12.020.
This study compared late radiation morbidity in patients with extremity soft tissue sarcoma randomized to treatment by pre- (50 Gy) or postoperative (66 Gy) radiotherapy in combination with surgery. The morbidities evaluated included fibrosis, joint stiffness and edema at 2 years following treatment. The impact of morbidity on patient function as measured by the Musculoskeletal Tumor Rating Scale (MSTS) and the Toronto Extremity Salvage Score (TESS) was also evaluated.
129 patients were evaluated. Toxicity rates were compared by treatment arm using the Fisher's exact test. Function scores by toxicity were analyzed using the Wilcoxon rank sum test. Multivariate logistic regression was used to evaluate the joint effect of treatment arm, field size, and dose on subcutaneous tissue fibrosis, joint stiffness and edema.
27 of 56 patients (48.2%) in the postoperative arm compared to 23 of 73 (31.5%) in the preoperative arm had grade 2 or greater fibrosis (P = 0.07). Although not statistically significant, edema was more frequent in the postoperative arm, 13 of 56 (23.2%) versus 11 of 73 (15.5%) in the preoperative arm, as was joint stiffness, 13 of 56 (23.2%) versus 13 of 73 (17.8%). Patients with significant fibrosis, joint stiffness or edema had significantly lower function scores on both measures (all P-values < 0.01). Field size was predictive of greater rates of fibrosis (P = 0.002) and joint stiffness (P = 0.006) and marginally predictive of edema (P = 0.06).
Patients treated with postoperative radiotherapy tended to have greater fibrosis. Fibrosis, joint stiffness and edema adversely affect patient function.
本研究比较了肢体软组织肉瘤患者接受术前（50 Gy）或术后（66 Gy）放疗联合手术治疗后的晚期放射并发症。评估的并发症包括治疗后2年的纤维化、关节僵硬和水肿。还评估了并发症对通过肌肉骨骼肿瘤评分量表（MSTS）和多伦多肢体挽救评分（TESS）测量的患者功能的影响。
对129例患者进行了评估。使用Fisher精确检验按治疗组比较毒性发生率。使用Wilcoxon秩和检验分析按毒性分类的功能评分。采用多因素逻辑回归评估治疗组、照射野大小和剂量对皮下组织纤维化、关节僵硬和水肿的联合影响。
术后组56例患者中有27例（48.2%）出现2级或更严重的纤维化，而术前组73例中有23例（31.5%）出现（P = 0.07）。虽然无统计学意义，但术后组水肿更常见，术后组56例中有13例（23.2%），术前组73例中有11例（15.5%）；关节僵硬情况也是如此，术后组56例中有13例（23.2%），术前组73例中有13例（17.8%）。出现明显纤维化、关节僵硬或水肿的患者在两项测量中的功能评分均显著较低（所有P值<0.01）。照射野大小可预测更高的纤维化发生率（P = 0.002）和关节僵硬发生率（P = 0.006），对水肿有边缘性预测作用（P = 0.06）。
接受术后放疗的患者往往有更严重的纤维化。纤维化、关节僵硬和水肿对患者功能有不利影响。
