Mark R J, Sercarz J A, Tran L, Selch M, Calcaterra T C
Department of Radiation Oncology, UCLA Medical Center 90024.
Arch Otolaryngol Head Neck Surg. 1991 Apr;117(4):396-401. doi: 10.1001/archotol.1991.01870160050007.
Between 1955 and 1987, twenty-nine patients with the diagnosis of fibrosarcoma of the head and neck were seen at the UCLA Medical Center. Follow-up ranged from 15 to 192 months, with a median of 66 months. Absolute 5-year survival was 62% (13/21). Five of 17 patients treated initially with surgery alone achieved local control and long-term survival. All five had low-grade lesions. Five patients received postoperative radiation therapy because of positive surgical margins. Three were rendered disease free, and all had low-grade lesions. Radiation therapy was used as primary treatment in six patients, four of whom received additional chemotherapy. Of these six, two are disease free with longer than 5-year follow-up. Surgery with and without adjuvant therapy successfully salvaged 42% (5/12) of the patients with local recurrence. Eighty percent (12/15) of the patients with low-grade lesions were ultimately rendered disease free vs only 8% (1/12) of the patients with high-grade histologic features. Seventy-two percent (13/18) of the patients with local recurrence were known to have positive surgical margins. Sixty-eight percent (13/19) of the patients with recurrent disease had high-grade lesions and/or tumor size larger than 5 cm. Tumor grade is the most important prognostic factor followed by tumor size and surgical margin status. Patients with low-grade lesions and adequate surgical margins are treated well with surgery alone. Patients with high-grade lesions or positive surgical margins should receive adjuvant treatment.
1955年至1987年间，加州大学洛杉矶分校医疗中心共收治了29例诊断为头颈部纤维肉瘤的患者。随访时间为15至192个月，中位随访时间为66个月。5年绝对生存率为62%（13/21）。17例最初仅接受手术治疗的患者中有5例实现了局部控制并长期存活。这5例均为低级别病变。17例患者中有5例因手术切缘阳性而接受了术后放疗。其中3例疾病得到控制，且均为低级别病变。6例患者接受放疗作为主要治疗，其中4例还接受了化疗。这6例患者中，2例在随访超过5年后疾病无进展。手术联合或不联合辅助治疗成功挽救了42%（5/12）局部复发的患者。低级别病变患者中有80%（12/15）最终疾病无进展，而高级别组织学特征患者中只有8%（1/12）。已知局部复发患者中有72%（13/18）手术切缘阳性。复发疾病患者中有68%（13/19）为高级别病变和/或肿瘤大小大于5 cm。肿瘤分级是最重要的预后因素，其次是肿瘤大小和手术切缘状态。低级别病变且手术切缘足够的患者仅通过手术即可得到良好治疗。高级别病变或手术切缘阳性的患者应接受辅助治疗。
