White J S, Biberdorf D, DiFrancesco L M, Kurien E, Temple W
Department of Surgical Oncology, Tom Baker Cancer Centre, Calgary, Canada.
Ann Surg Oncol. 2007 Feb;14(2):583-90. doi: 10.1245/s10434-006-9139-0. Epub 2006 Nov 9.
We report our experience of treating retroperitoneal sarcoma (RPS) using pre-operative external beam radiotherapy (EBRT) in combination with radical resectional surgery from 1990 to 2005.
Twenty-eight primary and 10 recurrent tumors were identified from a prospective database.
The resection rate was 71% overall; 82% in primary (23/28) and 40% (4/10) in recurrent cases. EBRT was administered preoperatively in 25 patients, postoperatively in 1, and palliatively in 11. In 33 patients a saline-filled tissue expander was inserted into the abdomen before radiotherapy to displace small bowel from the radiation field. 4,500-5,000 cGy was administered in fractions of 180-200 cGy over a 5-week period; surgery followed 6-8 weeks later. Expander insertion was associated with minimal morbidity; 31/37 patients received a dose of 4,000 cGy or more (median 4,650 cGy). Median resected tumor diameter was 13 cm, and a median of three adjacent organs was resected per patient. Complete macroscopic resection was achieved in 25/27 patients (93%); R0 in 9 (33%) and R1 in 13 (48%) (microscopic margins unclear in 5). There was no postoperative mortality. Tumors were high-grade in 20 patients, low-grade in 14 and ungraded in 4. Actuarial 5- and 10-year survival for all patients was 74 and 60%. For operable primary tumors, the 5-year survival and disease-free rates were 90 and 80%. In four patients with operable recurrent tumors, median disease-free interval was 91 months (27-160). In the 11 inoperable cases, median survival after radiotherapy was 48 months (9-77).
We conclude that a combination of pre-operative tissue expander placement, high-dose EBRT and radical resectional surgery can achieve acceptable morbidity, extended survival and low long-term recurrence in patients with RPS.
Median (interquartile range).
我们报告了1990年至2005年期间使用术前外照射放疗（EBRT）联合根治性手术治疗腹膜后肉瘤（RPS）的经验。
从一个前瞻性数据库中识别出28例原发性肿瘤和10例复发性肿瘤。
总体切除率为71%；原发性肿瘤切除率为82%（23/28），复发性肿瘤切除率为40%（4/10）。25例患者术前接受EBRT，1例术后接受EBRT，11例接受姑息性EBRT。33例患者在放疗前将充满生理盐水的组织扩张器插入腹部，以使小肠移出辐射野。在5周内分180 - 200 cGy的剂量给予4500 - 5000 cGy；6 - 8周后进行手术。扩张器插入的并发症极少；31/37例患者接受了4000 cGy或更高剂量（中位剂量4650 cGy）。切除肿瘤的中位直径为13 cm，每位患者中位切除三个相邻器官。25/27例患者（93%）实现了肉眼完全切除；R0切除9例（33%），R1切除13例（48%）（5例显微镜下切缘不清楚）。无术后死亡病例。20例患者肿瘤为高级别，14例为低级别，4例未分级。所有患者的5年和10年精算生存率分别为74%和60%。对于可手术切除的原发性肿瘤，5年生存率和无病生存率分别为90%和80%。4例可手术切除的复发性肿瘤患者，中位无病间期为91个月（27 - 160个月）。11例不可手术切除的病例，放疗后的中位生存期为48个月（9 - 77个月）。
我们得出结论，术前放置组织扩张器、高剂量EBRT和根治性手术相结合，可以使RPS患者的并发症可接受、生存期延长且长期复发率低。
中位数（四分位间距）
