Cleator S J, Cottrill C, Harmer C
Sarcoma Unit Royal Marsden Hospital NHS Trust London SW3 6JJ UK.
Sarcoma. 2001;5(2):83-8. doi: 10.1155/S1357714X01000160.
Over the past three decades our centre has adopted a policy of conservative surgery followed by adjuvant radicaldose radiotherapy for medium-and high-grade soft tissue sarcomas. For all cases of local recurrence following this treatment we aimed to define the spatial relationship between sites of recurrence and the positions of the phase 1 and 2 radiotherapy volumes.
We identified 25 cases of local recurrence recorded on our soft tissue sarcoma database between 1986 and 1999 inclusive. We excluded patients with macroscopic residual disease following surgery. Most patients were treated with a phase I volume corresponding to the entire muscle compartment (50 Gy in 25 fractions over 5 weeks) and a phase II volume corresponding to the tumour bed (10 Gy in five fractions). Six of the patients were treated according to a hyperfractionated regimen.
For each case we reviewed the diagnostic imaging, planning radiographs and prescription sheets. We audited whether treatment had been given according to protocol and defined whether recurrence had arisen in the phase 1 volume, phase 2 volume or 'out of field'.
Four (16%) patients recurred within the phase I volume, 17 (68%) recurred within the phase II volume and four (16%) outside the irradiated volume including one marginal recurrence. In six patients there had been deviation from our radiotherapy protocol (usually unavoidable) including all three true out of field recurrences.
The majority of recurrences occur in the phase 2 volume. Prospective multi-centre data collection and, ideally, a prospective randomised trial are required to formulate an improved treatment policy with respect to radiotherapy margins and dose.
在过去三十年中，我们中心对中、高级别软组织肉瘤采取了保守手术加辅助根治性剂量放疗的策略。对于所有接受该治疗后出现局部复发的病例，我们旨在明确复发部位与一期和二期放疗靶区位置之间的空间关系。
我们在软组织肉瘤数据库中确定了1986年至1999年（含）期间记录的25例局部复发病例。我们排除了术后有肉眼可见残留病灶的患者。大多数患者接受的一期靶区为整个肌间隙（5周内25次分割，每次2 Gy，共50 Gy），二期靶区为瘤床（5次分割，每次2 Gy，共10 Gy）。其中6例患者采用了超分割方案治疗。
对于每例病例，我们回顾了诊断影像、计划X光片和处方单。我们审核了治疗是否按照方案进行，并确定复发是出现在一期靶区、二期靶区还是“靶区外”。
4例（16%）患者在一期靶区内复发，17例（68%）在二期靶区内复发，4例（16%）在照射靶区外复发，其中包括1例边缘复发。6例患者的治疗偏离了我们的放疗方案（通常不可避免），包括所有3例真正的靶区外复发。
大多数复发发生在二期靶区内。需要进行前瞻性多中心数据收集，理想情况下进行前瞻性随机试验，以制定关于放疗边界和剂量的改进治疗策略。
