Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Cancer. 2011 Jun 1;117(11):2513-9. doi: 10.1002/cncr.25806. Epub 2011 Jan 18.
A study was undertaken to evaluate results of surgery and radiotherapy (RT) for high-risk extracranial chondrosarcomas.
Between 1986 and 2006, 60 patients underwent surgery and RT for extracranial high-risk chondrosarcoma. Preoperative RT (median, 50 gray [Gy]) and postoperative RT (median, 60 Gy) were used in 40% and 60% patients, respectively. Sites included pelvis/lower extremity (48%), chest wall (22%), spine/paraspinal (17%), and head and neck (13%). Overall, median tumor size was 7 cm (range, 1-22 cm), and tumor grade was I, II, and III in 22%, 64%, and 14% of cases, respectively.
Pathologically clear surgical margins (R0) were present in 50%, microscopic positive margins (R1) in 28%, and gross positive margins (R2) in 13%, half of whom had clinically detectable residual disease; surgical margin was unknown in 8%. Median follow-up was 75 months (range, 5-230 months). The crude local control rate was 90%. Patients with R0, R1, and R2 resections had local control of 100%, 94%, and 42%, respectively. Of the 8 cases that had R2 resection, 3 experienced uncontrolled progression, but 5 patients had stable disease with long-term follow-up. The 10-year overall survival, progression-free survival, and cause-specific survival were 86%, 80.5%, and 89.4%, respectively. Younger age and grade III tumors were associated with worse progression-free survival (P = .03 and .0003, respectively).
Although surgery with complete resection is paramount in management of chondrosarcoma, RT is a useful adjuvant treatment and appears to offer excellent and durable local control where wide surgical resection is difficult to accomplish.
本研究旨在评估颅外软骨肉瘤的手术和放疗（RT）治疗结果。
1986 年至 2006 年间，60 例颅外高危软骨肉瘤患者接受手术和 RT 治疗。40%和 60%的患者分别接受术前 RT（中位数 50 戈瑞[Gy]）和术后 RT（中位数 60 Gy）。发病部位包括骨盆/下肢（48%）、胸壁（22%）、脊柱/脊柱旁（17%）和头颈部（13%）。总体而言，肿瘤大小中位数为 7cm（范围 1-22cm），肿瘤分级为 I、II 和 III 级的分别占 22%、64%和 14%。
病理切缘完全（R0）为 50%，镜下阳性（R1）为 28%，肉眼阳性（R2）为 13%，其中一半有临床可检测到的残留肿瘤；8%的手术切缘情况未知。中位随访时间为 75 个月（范围 5-230 个月）。粗局部控制率为 90%。R0、R1 和 R2 切除患者的局部控制率分别为 100%、94%和 42%。R2 切除的 8 例中，3 例出现无控制进展，但 5 例疾病稳定，随访时间长。10 年总生存率、无进展生存率和特异性生存率分别为 86%、80.5%和 89.4%。年龄较小和 III 级肿瘤与无进展生存率差相关（P =.03 和.0003）。
虽然完全切除手术是软骨肉瘤治疗的关键，但 RT 是一种有用的辅助治疗方法，在广泛手术切除困难时，可提供出色且持久的局部控制效果。
