Robinson M, Barr L, Fisher C, Fryatt I, Stotter A, Harmer C, Wiltshaw E, Westbury G
Department of Radiotherapy, Royal Marsden Hospital, London, U.K.
Radiother Oncol. 1990 Jul;18(3):221-33. doi: 10.1016/0167-8140(90)90058-5.
The results of treatment with a combination of surgery and radiotherapy of 102 patients with nonmetastatic extremity soft tissue sarcoma are reported. Seventy-nine patients were previously untreated and 23 had locally recurrent disease. Sixty-six tumours were situated in the lower limb and 16 in the limb girdles. Fifty-nine were high grade lesions, and 64 were over 5 cm in length. Surgical clearance was "good" (wide or radical) in only 34 cases. Sixty-eight patients received post-operative irradiation, 23 pre-operative irradiation and 11 both pre- and post-operative radiotherapy. Seventeen patients subsequently developed local recurrence and 9 of these remain disease-free after further surgery. Actuarial 5 year local control and disease-free survival rates for new cases were 87 and 65.4%; and for previously recurrent cases these figures fell to 75 and 54.8%. Following a univariate analysis of patient, tumour, surgical and radiotherapeutic factors only previous local recurrence (p less than 0.1 greater than 0.05) was found to significantly increase the risk of further local relapse. Multivariate analysis found high tumour grade [relative risk (RR) 8.4], tumour size greater than 15 cm (RR 3.66), previous local recurrence (RR 6.47) and proximal site (RR 12.7) to be independent poor risk factors for survival.
报告了102例非转移性肢体软组织肉瘤患者接受手术和放疗联合治疗的结果。79例患者此前未接受过治疗，23例有局部复发性疾病。66个肿瘤位于下肢，16个位于肢体带。59个为高级别病变，64个长度超过5厘米。仅34例手术切缘“良好”（广泛或根治性）。68例患者接受术后放疗，23例接受术前放疗，11例接受术前和术后放疗。17例患者随后出现局部复发，其中9例在进一步手术后仍无疾病。新病例的5年精算局部控制率和无病生存率分别为87%和65.4%；既往复发病例的这些数字分别降至75%和54.8%。对患者、肿瘤、手术和放疗因素进行单因素分析后，仅发现既往局部复发（P<0.1且>0.05）会显著增加进一步局部复发的风险。多因素分析发现肿瘤高级别（相对风险[RR]8.4）、肿瘤大小大于15厘米（RR 3.66）、既往局部复发（RR 6.47）和近端部位（RR 12.7）是生存的独立不良风险因素。
