Greiner R H, Munkel G, Blattmann H, Coray A, Kann R, Pedroni E, Thum P
Paul Scherrer Institute (PSI), Division of Radiation Medicine, Villigen-PSI, Switzerland.
Int J Radiat Oncol Biol Phys. 1992;22(2):333-41. doi: 10.1016/0360-3016(92)90051-i.
Local tumor control remains a continuing challenge in the treatment of retroperitoneal soft tissue sarcoma. Though complete resection by means of wide excision or excisional biopsy can be performed in a minority of patients only, aggressive surgical approach remains the treatment of choice. Unresectable sarcoma can rarely be controlled by conventionally applied radiotherapy--only a few percent of patients survive. A superior dose distribution of external radiation is demanded in order to spare healthy tissue. The presumably greatest advantage will occur when radiotherapy is used preoperatively. The possible clinical gain of superior dose distribution is demonstrated by results of the dynamic, 3-D conformal pion radiotherapy at PSI. Between April 1983 and June 1988 a total of 21 patients were treated with high doses (greater than or equal to 30 Gy) for unresectable retroperitoneal soft tissue sarcoma. The follow-up time is 13-74 months, median 24. Fifteen patients were treated with 20 fx, and 19 patients were treated with fraction sizes of 150 or 165 cGy. Except for one patient with thrombocytopenia after chemotherapy, no treatment interruption was necessary. Five patients developed late reactions, caused also by surgery and chemotherapy: two intestinal obstructions, one liver abscess, one leg edema, and one superficial skin necrosis. Nine patients had laparotomy after pion irradiation, five for resection of the previous unresectable tumor; 3/5 sarcoma were completely resected. Morbidity rate after post-pion laparotomy did not increase. Three patients had local tumor progression, 1/3 inside the treatment volume. The actuarial five-year local tumor control rate of these unresectable retroperitoneal sarcoma is 60%, the actuarial five-year survival rate is 33%. Out of the 21 patients, 15 are alive, two have died from local progression, one from peritoneal progression, and three from metastases.
在腹膜后软组织肉瘤的治疗中，局部肿瘤控制仍然是一个持续存在的挑战。尽管只有少数患者能够通过广泛切除或切除活检实现完全切除，但积极的手术方法仍是首选治疗方式。不可切除的肉瘤很少能通过传统放疗得到控制，只有少数患者存活。为了保护健康组织，需要更优的外照射剂量分布。术前使用放疗可能会带来最大的益处。瑞士保罗谢尔研究所（PSI）的动态三维适形π介子放疗结果证明了更优剂量分布可能带来的临床获益。1983年4月至1988年6月期间，共有21例不可切除的腹膜后软组织肉瘤患者接受了高剂量（大于或等于30 Gy）放疗。随访时间为13 - 74个月，中位时间为24个月。15例患者接受了20次分割照射，19例患者的分割剂量为150或165 cGy。除1例患者化疗后出现血小板减少外，无需中断治疗。5例患者出现晚期反应，也是由手术和化疗引起的：2例肠梗阻、1例肝脓肿、1例腿部水肿和1例浅表皮肤坏死。9例患者在π介子照射后接受了剖腹手术，5例用于切除之前不可切除的肿瘤，其中3/5的肉瘤被完全切除。π介子放疗后剖腹手术的发病率没有增加。3例患者出现局部肿瘤进展，其中1/3发生在治疗区域内。这些不可切除的腹膜后肉瘤的精算五年局部肿瘤控制率为60%，精算五年生存率为33%。21例患者中，15例存活，2例死于局部进展，1例死于腹膜进展，3例死于转移。
