Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Int J Radiat Oncol Biol Phys. 2011 Sep 1;81(1):150-7. doi: 10.1016/j.ijrobp.2010.05.005. Epub 2011 May 6.
To evaluate the prognostic factors, outcomes, and complications in patients aged ≤30 years with resectable nonrhabdomyosarcoma soft-tissue sarcoma treated at the University of Florida with radiotherapy (RT) during a 34-year period.
A total of 95 pediatric or young adult patients with nonrhabdomyosarcoma soft-tissue sarcoma were treated with curative intent with surgery and RT at the University of Florida between 1973 and 2007. The most common histologic tumor subtypes were synovial sarcoma in 22 patients, malignant fibrous histiocytoma in 19, and malignant peripheral nerve sheath tumor in 11 patients. The mean age at RT was 22 years (range, 6-30). Of the 95 patients, 73 had high-grade tumors; 45 had undergone preoperative RT and 50 postoperative RT. The prognostic factors for survival, local recurrence, and distant recurrence were analyzed.
The median follow-up was 7.2 years (range, 0.4-30.5). The actuarial 5-year local control rate was 88%. A microscopically negative margin was associated with superior local control. Although 83% of local recurrence cases initially developed in the absence of metastases, all patients with local failure ultimately died of their disease. The actuarial estimate of 5-year overall survival and disease-free survival was 65% and 63%, respectively. Of all the deaths, 92% were disease related. An early American Joint Committee on Cancer stage, tumor<8 cm, and the absence of neurovascular invasion were associated with superior disease-free survival. The National Cancer Institute Common Toxicity Criteria, version 3, Grade 3-4 treatment complication rate was 9%. No secondary malignancies were observed.
In the present large single-institution study, we found positive margins and locally advanced features to be poor prognostic factors for both local progression and survival. The results from the present study have helped to characterize the therapeutic ratio of RT in pediatric and young adult sarcoma patients and have provided a basis for identifying high-risk patients for whom treatment intensification might be justified.
评估在佛罗里达大学接受放疗的 30 岁以下可切除非横纹肌肉瘤软组织肉瘤患者的预后因素、结果和并发症，该研究时间段为 34 年。
1973 年至 2007 年间，共有 95 名患有非横纹肌肉瘤软组织肉瘤的儿科或青年患者在佛罗里达大学接受了手术和放疗的根治性治疗。最常见的组织学肿瘤亚型包括 22 例滑膜肉瘤、19 例恶性纤维组织细胞瘤和 11 例恶性外周神经鞘瘤。放疗时的平均年龄为 22 岁（范围：6-30 岁）。95 例患者中，73 例为高级别肿瘤；45 例患者接受了术前放疗，50 例患者接受了术后放疗。分析了生存、局部复发和远处复发的预后因素。
中位随访时间为 7.2 年（范围：0.4-30.5 年）。5 年局部控制率的累积生存率为 88%。显微镜下阴性切缘与更好的局部控制相关。尽管 83%的局部复发病例最初没有转移，但所有局部复发失败的患者最终都死于疾病。5 年总生存率和无病生存率的估计值分别为 65%和 63%。所有死亡病例中，92%与疾病相关。早期美国癌症联合委员会分期、肿瘤<8cm 和无神经血管侵犯与更好的无病生存率相关。美国国家癌症研究所常见毒性标准，版本 3，3-4 级治疗并发症发生率为 9%。未观察到继发性恶性肿瘤。
在目前的大型单机构研究中，我们发现阳性切缘和局部晚期特征是局部进展和生存的不良预后因素。本研究的结果有助于描述儿科和青年肉瘤患者放疗的治疗比，并为确定需要强化治疗的高危患者提供了依据。
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