Pawlik Timothy M, Ahuja Nita, Herman Joseph M
Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 22187-6681, USA.
Curr Opin Oncol. 2007 Jul;19(4):359-66. doi: 10.1097/CCO.0b013e328122d757.
This review focuses on the current concepts relating to the use of radiation therapy in the care of surgical patients with retroperitoneal sarcoma. Radiation therapy for retroperitoneal sarcoma patients is complex because it requires decisions on not only the timing of administration, but also the technique of delivery.
Multiple studies have reported improved local recurrence-free survival in patients who received adjuvant external beam radiation therapy. Recent studies have demonstrated the efficacy of more sophisticated delivery methods for radiation therapy to deliver high dose rates while sparing surrounding normal tissues. Other recent studies have demonstrated the safety and feasibility of preoperative radiation therapy for retroperitoneal sarcoma. Preoperative radiation results in decreased local recurrence rates and minimal toxicity. The use of intraoperative radiation therapy has also been examined as a means to improve local recurrence rates, but may be associated with more radiation-related morbidity.
There is good evidence that radiation therapy improves local control rates. Preoperative external beam radiation therapy may be the preferred sequence to improve tumor resectability and local-regional control with less risk of complications. Although data suggest that the addition of intraoperative radiation therapy to external beam radiation therapy improves local control, intraoperative radiation therapy may be related to additional toxicity.
本综述聚焦于与放射治疗用于腹膜后肉瘤手术患者护理相关的当前概念。腹膜后肉瘤患者的放射治疗很复杂，因为不仅需要决定给药时机，还需要决定给药技术。
多项研究报告称，接受辅助性外照射放疗的患者局部无复发生存率有所提高。近期研究已证明更复杂的放疗给药方法在高剂量率放疗同时保护周围正常组织方面的有效性。其他近期研究已证明术前放疗用于腹膜后肉瘤的安全性和可行性。术前放疗可降低局部复发率且毒性极小。术中放疗的应用也已作为提高局部复发率的一种手段进行了研究，但可能与更多的放疗相关并发症有关。
有充分证据表明放射治疗可提高局部控制率。术前外照射放疗可能是提高肿瘤可切除性和局部区域控制且并发症风险较低的首选方案。尽管数据表明在体外照射放疗基础上加用术中放疗可改善局部控制，但术中放疗可能与额外的毒性有关。
