Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 2010 Mar 15;76(4):1154-60. doi: 10.1016/j.ijrobp.2009.03.067. Epub 2009 Aug 3.
We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis.
Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy).
After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (>31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients.
Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease.
我们分析了在保器官手术切除后采用术中电子放射治疗（IOERT）联合中等剂量外照射放射治疗（EBRT）治疗原发性或复发性侵袭性纤维瘤病患者的经验。
当完全手术切除似乎不太可能或不可能时，我们认为 IOERT 和术后 EBRT 是避免致残性手术的一种单独治疗方法。共 30 名患者的 31 个病灶接受了手术和 IOERT 治疗，中位剂量为 12 Gy。中位年龄为 31 岁（范围 13-59 岁）。6 个病灶切缘接近，13 个病灶镜下阳性，12 个病灶肉眼阳性。肿瘤中位大小为 9 cm。共有 25 名患者接受了额外的 EBRT，中位剂量为 45 Gy（范围 36-54 Gy）。
中位随访 32 个月（范围 3-139 个月）后，无疾病相关死亡。共发生 5 例局部复发，总体 3 年局部控制率为 82%，IOERT 区域内为 91%。年龄较大（>31 岁）和切缘阴性的患者有改善局部控制的趋势，但这些因素均无统计学意义。6 例患者发生围手术期并发症，特别是 5 例患者出现伤口愈合障碍，1 例患者发生静脉血栓形成。5 例患者出现晚期毒性。
在侵袭性纤维瘤病患者的多模态治疗方法中引入 IOERT 是可行的，毒性低，即使在显微镜下或肉眼残留疾病的患者中也能获得良好的局部控制率。
