Dunst J, Sauer R, Burgers J M, Hawliczek R, Kürten R, Winkelmann W, Salzer-Kuntschik M, Müschenich M, Jürgens H
Department of Radiotherapy, University of Erlangen, FRG.
Cancer. 1991 Jun 1;67(11):2818-25. doi: 10.1002/1097-0142(19910601)67:11<2818::aid-cncr2820671118>3.0.co;2-y.
The Cooperative Ewing's Sarcoma Studies, CESS 81 and CESS 86, are multiinstitutional trials with more than 80 participating institutions from Germany, the Netherlands, Austria, and Switzerland. Treatment consists of four courses of multiagent chemotherapy and local therapy. Local therapy was not randomized and was either radical surgery or resection plus postoperative irradiation or definitive radiation therapy. Here results according to local therapy have been analyzed for 93 protocol patients with localized Ewing's sarcoma (ES) who have been recruited in CESS 81 from January 1981 to February 1985 and 122 protocol patients recruited in CESS 86 from January 1986 to November 1989. The 3-year relapse-free survival (RFS) was 55% in CESS 81 and 62% in CESS 86. In CESS 81, the RFS was better for surgically treated than for irradiated patients. In this study there was an extremely high incidence of local failures (50%) after definitive irradiation. In CESS 86, however, the results after radiation therapy have been improved markedly (3-year RFS 67% after radiation therapy, 65% after surgery, and 62% after resection plus irradiation). Possible explanations for the improvement of radiotherapeutic results are as follows: selections for patients for radiation therapy, start of local therapy, and quality of radiation therapy. In CESS 86, irradiated patients were randomized to receive either conventionally fractionated irradiation with less intense chemotherapy or hyperfractionated irradiation with simultaneous chemotherapy. There was no difference in treatment results at the time of analysis. The authors conclude that selection of patients for local treatment modalities and quality of treatment performance has an impact on local and overall treatment results in ES.
尤因肉瘤协作研究（CESS 81和CESS 86）是多机构试验，有来自德国、荷兰、奥地利和瑞士的80多个参与机构。治疗包括四个疗程的多药化疗和局部治疗。局部治疗未进行随机分组，采用根治性手术、切除加术后放疗或根治性放疗。本文分析了1981年1月至1985年2月在CESS 81中招募的93例局限性尤因肉瘤（ES）方案患者以及1986年1月至1989年11月在CESS 86中招募的122例方案患者根据局部治疗的结果。CESS 81中的3年无复发生存率（RFS）为55%，CESS 86中为62%。在CESS 81中，手术治疗患者的RFS优于接受放疗的患者。在本研究中，根治性放疗后局部失败的发生率极高（50%）。然而，在CESS 86中，放疗后的结果有了显著改善（放疗后3年RFS为67%，手术治疗后为65%，切除加放疗后为62%）。放疗结果改善的可能原因如下：放疗患者的选择、局部治疗的开始时间以及放疗质量。在CESS 86中，接受放疗的患者被随机分为接受化疗强度较低的常规分割放疗或同步化疗的超分割放疗。分析时治疗结果无差异。作者得出结论，局部治疗方式的患者选择和治疗实施质量对ES的局部和总体治疗结果有影响。
