Bacci Gaetano, Longhi Alessandra, Briccoli Antonio, Bertoni Franco, Versari Michela, Picci Piero
Section of Chemotherapy, Department of Musculoskeletal Oncology, Istituti Ortopedici Rizzoli, Bologna, Italy.
Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):766-72. doi: 10.1016/j.ijrobp.2006.01.019. Epub 2006 Apr 19.
To evaluate the importance of surgical margins for local and systemic control of Ewing's sarcoma family tumors (ESFT).
Between 1979 and 1999, 512 patients with ESFTs entered 4 different adjuvant and neoadjuvant studies performed at a single institution. Of these patients, 335 were treated with surgery alone (196) or surgery followed by radiotherapy at doses of 44.8 Gy (139). We compared their outcome with that of the 177 patients who were locally treated by radiotherapy at 60 Gy.
Local control (88.8% vs. 80.2%, p < 0.009) and 5-year disease-free survival (63.8% vs. 47.6%, p < 0.0007) were significantly better in patients treated with surgery and, among them, in those with adequate surgical margins (96.6% vs. 71,7%, p < 0.0008, and 69.6% vs. 46.3%, p < 0.0002). Nonetheless, better results were observed only in extremity tumors.
Surgery is better than radiotherapy in cases of extremity ESFT with achievable adequate surgical margins, and in cases of inadequate surgical margins, adjuvant reduced-dose radiotherapy is ineffective. Therefore, when inadequate margins are expected, patients are better treated with full-dose radiotherapy from the start.
评估手术切缘对尤因肉瘤家族性肿瘤（ESFT）局部和全身控制的重要性。
1979年至1999年间，512例ESFT患者参加了在单一机构进行的4项不同的辅助和新辅助研究。在这些患者中，335例仅接受手术治疗（196例）或手术后接受44.8 Gy剂量的放疗（139例）。我们将他们的结果与177例接受60 Gy局部放疗的患者的结果进行了比较。
接受手术治疗的患者，尤其是手术切缘足够的患者，局部控制率（88.8%对80.2%，p<0.009）和5年无病生存率（63.8%对47.6%，p<0.0007）明显更好。然而，仅在肢体肿瘤中观察到更好的结果。
对于可实现足够手术切缘的肢体ESFT病例，手术优于放疗；对于手术切缘不足的病例，辅助低剂量放疗无效。因此，当预期切缘不足时，患者从一开始就接受全剂量放疗效果更好。
