Mack Lloyd A, Crowe Phil J, Yang Jia Lin, Schachar Norman S, Morris Don G, Kurien Elizabeth C, Temple Claire L F, Lindsay Robert L, Magi Enzio, DeHaas William G, Temple Walley J
Division of Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29th Street N.W., Calgary, Alberta, Canada T2N 4N2.
Ann Surg Oncol. 2005 Aug;12(8):646-53. doi: 10.1245/ASO.2005.03.064. Epub 2005 Jun 20.
Local recurrence rates of 15% to 30% after treatment of soft tissue sarcoma (STS) are still common but unacceptable. Our hypothesis was that a refined neoadjuvant chemotherapy and radiation protocol (modified Eilber protocol) improves local control rates while minimizing major morbidity.
Consecutive patients with STS deep to the fascia of the extremity or trunk during 1984 to 1996 were treated with 3 days of doxorubicin (30 mg/day) and sequential radiation (300 cGy/day for 10 days). Wide excision with limb preservation was performed 4 to 8 weeks after radiation completion. Treatment complications, margins, local recurrence, and survival were prospectively documented.
Of 75 patients, 66% had tumors >5 cm, and 71% were grade 2/3. In eight patients, negative margins were not achieved, and four of these had amputation (95% limb salvage). Three of the remaining four had local recurrence with a 5- and 7-year actuarial local control rate of 50% and 25%, respectively. In contrast, of the 67 patients with negative margins, a local control rate of 97% at 5 years and 94% at 7 years and an overall survival of 63% were achieved. Although margin (P = .001) and stage (P = .035) were correlated, these were not significant on multivariate Cox regression analysis. Risk factors for death included tumor stage (hazard ratio, 1.54; P = .001) and tumor grade (hazard ratio, 1.4; P = .02). Three patients (4%) required reoperation for tissue loss, and eight patients (10.6%) developed minor wound complications.
This modified Eilber protocol seems to maximize local control and minimize major wound complications for extremity/truncal STS.
软组织肉瘤（STS）治疗后15%至30%的局部复发率仍然很常见，但令人难以接受。我们的假设是，一种优化的新辅助化疗和放疗方案（改良的埃尔伯方案）可提高局部控制率，同时将主要并发症降至最低。
1984年至1996年期间，对肢体或躯干筋膜深层的连续性STS患者给予3天的阿霉素（30毫克/天）治疗，并序贯放疗（300厘戈瑞/天，共10天）。放疗结束后4至8周进行保肢的广泛切除。前瞻性记录治疗并发症、切缘、局部复发和生存率。
75例患者中，66%的肿瘤直径>5厘米，71%为2/3级。8例患者切缘阴性未实现，其中4例行截肢术（保肢率95%）。其余4例中有3例发生局部复发，5年和7年的精算局部控制率分别为50%和25%。相比之下，67例切缘阴性的患者5年局部控制率为97%，7年为94%，总生存率为63%。虽然切缘（P = 0.001）和分期（P = 0.035）相关，但在多变量Cox回归分析中这些并不显著。死亡的危险因素包括肿瘤分期（风险比，1.54；P = 0.001）和肿瘤分级（风险比，1.4；P = 0.02）。3例患者（4%）因组织缺损需要再次手术，8例患者（10.6%）出现轻微伤口并发症。
这种改良的埃尔伯方案似乎能最大限度地提高肢体/躯干STS的局部控制率，并将主要伤口并发症降至最低。
