Shaheen Mahmood, Deheshi Benjamin M, Riad Soha, Werier Joel, Holt Ginger E, Ferguson Peter C, Wunder Jay S
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada.
Clin Orthop Relat Res. 2006 Sep;450:76-81. doi: 10.1097/01.blo.0000229315.58878.c1.
Radiation-induced sarcoma of bone (RISB) is thought to be associated with a poor prognosis. The purpose of this study was to determine disease-free and overall survival of patients treated for RISB, and whether there is a role for limb sparing surgery. Twenty-four patients had a mean latency of 16 years between radiation for their index cancer and RISB diagnosis. The most common tumor was osteosarcoma (n = 17). Ten patients with localized disease treated aggressively with chemotherapy and surgical resection had estimated 5-year disease-free and overall survival rates of 58% and 69% respectively. Patients treated by surgery alone or those with metastases at diagnosis had inferior outcomes. Patients who received a complete course of chemotherapy demonstrated better histologic tumor response and improved survival. There was no difference in survival between the limb sparing surgery (n = 12) or amputation (n = 8) groups. However, limb salvage patients had slightly higher rates of local tumor relapse and post-operative complications. Functional outcome following limb sparing surgery for 10 patients with RISB was similar to a matched cohort treated for primary osteosarcoma. An aggressive treatment approach for patients with RISB may provide similar rates of local recurrence and metastasis and functional outcomes compared to patients with primary osteosarcoma.
Therapeutic study, level IV-1.
骨放射性肉瘤（RISB）被认为预后较差。本研究的目的是确定接受RISB治疗患者的无病生存期和总生存期，以及保肢手术是否起作用。24例患者在其原发癌放疗与RISB诊断之间的平均潜伏期为16年。最常见的肿瘤是骨肉瘤（n = 17）。10例接受积极化疗和手术切除的局限性疾病患者的估计5年无病生存率和总生存率分别为58%和69%。仅接受手术治疗的患者或诊断时有转移的患者预后较差。接受完整化疗疗程的患者显示出更好的组织学肿瘤反应和生存率提高。保肢手术组（n = 12）和截肢组（n = 8）的生存率无差异。然而，保肢患者的局部肿瘤复发率和术后并发症发生率略高。10例RISB患者保肢手术后的功能结果与一组匹配的原发性骨肉瘤治疗患者相似。与原发性骨肉瘤患者相比，对RISB患者采取积极的治疗方法可能会提供相似的局部复发和转移率以及功能结果。
治疗性研究，IV-1级。
