Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):843-50. doi: 10.1016/j.ijrobp.2009.06.086. Epub 2009 Dec 16.
There is little information on the appropriate three-dimensional (3D) preoperative radiotherapy (XRT) volume for extremity soft-tissue sarcomas (STS). We retrospectively analyzed the pattern of local failure (LF) to help elucidate optimal field design.
We analyzed the 56 patients who underwent computed tomography-planned XRT for Stage I to III extremity STS between June 2000 and December 2006. Clinical target volume (CTV) included the T1 post-gadolinium-defined gross tumor volume with 1- to 1.5-cm radial and 3.5-cm longitudinal margins. Planning target volume expansion was 5 to 7 mm, and >or=95% of dose was delivered to the planning target volume. Preoperative XRT was 44 to 50.4 Gy (median, 50). Postoperative boost of 10 to 20 Gy was given to 12 patients (6 with positive and 6 with close margins).
Follow-up ranged from 15 to 76 months (median, 41 months). The 5-year local control, freedom from distant metastasis, disease-free survival, and overall survival were 88.5%, 80.0%, 77.5% and 82.8%, respectively. Three patients (all with positive margin) experienced local failure (LF) as first relapse (2 isolated, 1 with distant failure), and 2 additional patients (all with margin<1 mm) had late LF after distant metastasis. The LFs were within the CTV in 3 patients and within and also extending beyond the CTV in 2 patients.
These target volume definitions appear to be appropriate for most patients. No local recurrences were observed with surgical margins >or=1 mm, and it appears that these may be adequate for patients with extremity STS treated with preoperative radiotherapy.
关于肢体软组织肉瘤（STS）适当的三维（3D）术前放疗（XRT）体积，信息很少。我们回顾性分析局部失败（LF）的模式，以帮助阐明最佳的野设计。
我们分析了 2000 年 6 月至 2006 年 12 月期间接受 CT 规划 XRT 的 56 例 I 期至 III 期肢体 STS 患者。临床靶区（CTV）包括 T1 后钆定义的大体肿瘤体积，径向 1-1.5cm 和纵向 3.5cm。计划靶区扩展为 5-7mm，计划靶区的剂量>或=95%。术前 XRT 为 44-50.4Gy（中位数，50）。12 例患者给予 10-20Gy 的术后加量（阳性边缘 6 例，接近边缘 6 例）。
随访时间为 15-76 个月（中位数，41 个月）。5 年局部控制率、无远处转移生存率、无病生存率和总生存率分别为 88.5%、80.0%、77.5%和 82.8%。3 例患者（均为阳性边缘）首次复发出现局部失败（LF）（2 例孤立，1 例远处失败），2 例额外患者（均为边缘<1mm）在远处转移后出现晚期 LF。3 例 LF 位于 CTV 内，2 例位于 CTV 内并延伸至 CTV 外。
这些靶区定义似乎适用于大多数患者。手术边缘>或=1mm 无局部复发，对于接受术前放疗的肢体 STS 患者，这些边缘似乎足够。
