Indelicato Daniel J, Keole Sameer R, Shahlaee Amir H, Shi Wenyin, Morris Christopher G, Gibbs Charles P, Scarborough Mark T, Marcus Robert B
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):501-9. doi: 10.1016/j.ijrobp.2007.06.032. Epub 2007 Sep 12.
Retrospective review describing the 35-year University of Florida experience with Ewing's tumors of the lower extremity.
Fifty-three patients were treated between 1971 and 2006. Thirty patients were treated with radiotherapy (RT) alone and 23 patients were treated with surgery +/- RT. Larger tumors and tumors of the femur were treated more often with definitive RT. Median potential follow-up was 19.2 years. Functional outcome was assessed using the Toronto Extremity Salvage Score (TESS).
Before 1985, 24% of patients were treated with surgery; since then, the rate has increased to 61%. The 15-year actuarial overall survival (OS), cause-specific survival (CSS), freedom from relapse, and limb preservation rates were 68% vs. 47% (p = 0.21), 73% vs. 47% (p = 0.13), 73% vs. 40% (p = 0.03), and 43% vs. 40% (p = 0.52), respectively, for patients treated with surgery +/- RT vs. RT alone. Excluding 8 patients who underwent amputation or rotationplasty, the 15-year actuarial local control rate was 100% for the surgery +/- RT group and 68% for the definitive RT group (p = 0.03). The ranges of the TESS for surgery +/- RT vs. RT alone were 70-100 (mean, 94) and 97-100 (mean, 99), respectively. Twenty-six percent (6/23) of patients had complications related to surgery requiring amputation or reoperation.
Overall survival and CSS were not statistically compromised, but we observed an increased risk of relapse and local failure in patients treated with RT alone, thereby justifying a transition toward primary surgical management in suitable patients. However, despite an adverse risk profile, patients treated with RT alone had similar long-term amputation-free survival and demonstrated comparable functional outcomes. Poor results observed in Ewing's of the femur mandate innovative surgical and RT strategies.
回顾性分析佛罗里达大学35年来治疗下肢尤因肉瘤的经验。
1971年至2006年间共治疗53例患者。30例患者仅接受放射治疗（RT），23例患者接受手术±RT治疗。较大的肿瘤和股骨肿瘤更常采用根治性RT治疗。中位潜在随访时间为19.2年。使用多伦多肢体挽救评分（TESS）评估功能结局。
1985年前，24%的患者接受手术治疗；此后，这一比例增至61%。接受手术±RT治疗的患者与仅接受RT治疗的患者相比，15年精算总生存率（OS）、病因特异性生存率（CSS）、无复发生存率和保肢率分别为68%对47%（p = 0.21）、73%对47%（p = 0.13）、73%对40%（p = 0.03）和43%对40%（p = 0.52）。排除8例行截肢或旋转成形术的患者后，手术±RT组的15年精算局部控制率为100%，根治性RT组为68%（p = 0.03）。手术±RT组与仅接受RT治疗组的TESS范围分别为70 - 100（平均94）和97 - 100（平均99）。26%（6/23）的患者出现与手术相关的并发症，需要截肢或再次手术。
总体生存率和CSS无统计学差异，但我们观察到仅接受RT治疗的患者复发和局部失败风险增加，因此对于合适的患者有理由转向主要手术治疗。然而，尽管风险状况不利，仅接受RT治疗的患者长期无截肢生存率相似，且功能结局相当。在股骨尤因肉瘤中观察到的不良结果需要创新的手术和RT策略。
