Ballo Matthew T, Zagars Gunar K, Pollock Raphael E, Benjamin Robert S, Feig Barry W, Cormier Janice N, Hunt Kelly K, Patel Shreyaskumar R, Trent Jonathan C, Beddar Sam, Pisters Peter W T
Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):158-63. doi: 10.1016/j.ijrobp.2006.08.025. Epub 2006 Nov 2.
To evaluate the clinical outcomes of patients with localized retroperitoneal soft tissue sarcoma (STS) treated with complete surgical resection and radiation.
The medical records of 83 patients were reviewed retrospectively. Sixty patients presented with primary disease and the remaining 23 had recurrence after previous surgical resection.
With a median follow-up of 47 months, the actuarial overall disease-specific survival (DSS), distant metastasis-free survival, and local control (LC) rates were 44%, 67%, and 40%, respectively. Of the 38 patients dying of disease, local disease progression was the sole site of recurrence for 16 patients and was a component of progression for another 11 patients. Multivariate analysis indicated that histologic grade was associated with the 5-year rates of DSS (low-grade, 92%; intermediate-grade, 51%; and high-grade, 41%, p = 0.006). Multivariate analysis also indicated an inferior 5-year LC rate for patients presenting with recurrent disease, positive or uncertain resection margins, and age greater than 65 years. The data did not suggest an improved local control with higher doses of external-beam radiation (EBRT) or with the specific use of intraoperative radiotherapy (IORT). Radiation-related complications (10% at 5 years) developed in 5 patients; all had received their EBRT postoperatively.
Although preoperative radiation therapy and aggressive surgical resection is well tolerated in patients, local disease progression continues to be a significant component of disease death. In this small cohort of patients, the use of higher doses of EBRT or IORT did not result in clinically apparent improvements in outcomes.
评估接受完整手术切除和放疗的局限性腹膜后软组织肉瘤（STS）患者的临床结局。
回顾性分析83例患者的病历。60例为原发性疾病患者，其余23例为先前手术切除后复发患者。
中位随访47个月，精算总疾病特异性生存率（DSS）、无远处转移生存率和局部控制（LC）率分别为44%、67%和40%。在38例死于疾病的患者中，局部疾病进展是16例患者复发的唯一部位，是另外11例患者进展的一个组成部分。多因素分析表明，组织学分级与5年DSS率相关（低级别，92%；中级别，51%；高级别，41%，p = 0.006）。多因素分析还表明，复发疾病、切缘阳性或不确定以及年龄大于65岁的患者5年LC率较低。数据未显示更高剂量的外照射放疗（EBRT）或术中放疗（IORT）的特定使用能改善局部控制。5例患者出现放疗相关并发症（5年时为10%）；所有患者均在术后接受了EBRT。
尽管术前放疗和积极的手术切除在患者中耐受性良好，但局部疾病进展仍然是疾病死亡的重要组成部分。在这个小队列患者中，使用更高剂量的EBRT或IORT并未导致临床结局有明显改善。
