Habrand J L, Gerbaulet A, Pejovic M H, Contesso G, Durand S, Haie C, Genin J, Schwaab G, Flamant F, Albano M
Department of Radiation Medicine, Institut Gustave Roussy, Villejuif, France.
Int J Radiat Oncol Biol Phys. 1991 Mar;20(3):405-11. doi: 10.1016/0360-3016(91)90049-a.
From February 1968 to February 1988, 50 patients above 10 years of age with a soft tissue sarcoma were treated with interstitial brachytherapy, combined with a wide excision. After pathologic review, 48 were included in the final analysis. A pathological grading was made possible in 41, which showed a majority of high grades (2 + 3 = 86%). Patients presented mainly with small (less than 5 cm: 36) or mid-size lesions (greater than 5 cm: 12). The tumor was located in the limbs (32), trunk (9), and head and neck (7). Four patients had metastases at the time of treatment. Brachytherapy was part of the initial treatment in 22 cases, and of a salvage procedure after previous excision(s) combined or not with another form of treatment in 26. A uniform technique of iridium 192 wires after-loaded in plastic tubing was used. Sixty Gy median doses were delivered with brachytherapy alone (44) or combined with external beam (4). Sixteen patients also received an adjuvant chemotherapy. Follow up ranged from 16 months to 20 years (median 82 months). At the time of analysis, two patients (4%) only had failed in the irradiated volume, but the marginal failures rate (14:31%) was unexpectedly high. Seven of the patients who failed (43%) were salvaged by a second similar procedure. The 5-year survival was 62% in non-previously treated patients and 56.5% in previously treated ones (pNS). By multivariate analysis, only the tumor location appeared predictive of LF (p less than 0.01), which in turn was strongly correlated with the metastatic outcome (p less than 0.01). Necroses were observed in 17 cases (35%) and associated with a benign course in most of them. High dose brachytherapy combined with conservative surgery is highly effective in small and mid-size soft tissue sarcomas located in the extremities and head and neck, whereas in trunk and in recurrent tumors, the adjunction of large fields external radiotherapy and/or possibly polychemotherapy appears necessary.
1968年2月至1988年2月，对50例10岁以上的软组织肉瘤患者采用组织间近距离放射治疗，并联合广泛切除。经病理检查后，48例纳入最终分析。41例可行病理分级，其中大多数为高级别（2+3级：86%）。患者主要表现为小病灶（小于5cm：36例）或中等大小病灶（大于5cm：12例）。肿瘤位于四肢（32例）、躯干（9例）和头颈部（7例）。4例患者在治疗时已有转移。近距离放射治疗在22例中作为初始治疗的一部分，在26例中作为先前切除后（联合或不联合其他治疗形式）的挽救性治疗手段。采用了将铱192线后装于塑料管中的统一技术。单独使用近距离放射治疗给予的中位剂量为60Gy（44例），或联合外照射（4例）。16例患者还接受了辅助化疗。随访时间为16个月至20年（中位时间82个月）。在分析时，仅2例患者（4%）在照射野内出现失败，但边缘失败率（14例：31%）出乎意料地高。7例失败患者（43%）通过第二次类似手术得以挽救。未接受过先前治疗的患者5年生存率为62%，接受过先前治疗的患者为56.5%（无显著性差异）。多因素分析显示，仅肿瘤部位对局部失败有预测性（p<0.01），而局部失败又与转移结局密切相关（p<0.01）。17例（35%）出现坏死，大多数坏死与良性病程相关。高剂量近距离放射治疗联合保守手术对位于四肢和头颈部的小及中等大小软组织肉瘤高度有效，而对于躯干和复发性肿瘤，附加大野外照射和/或可能的多药化疗似乎是必要的。
