Lee Jieun, Park Young Je, Yang Dae Sik, Yoon Won Sup, Lee Jung Ae, Rim Chai Hong, Kim Chul Yong
Department of Radiation Oncology, Korea University Medical Center, Seoul, Korea.
Radiat Oncol J. 2012 Jun;30(2):62-9. doi: 10.3857/roj.2012.30.2.62. Epub 2012 Jun 30.
To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS).
Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy.
The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%).
Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
评估肢体软组织肉瘤（STS）术后放疗的治疗效果及预后因素。
1981年1月至2010年12月期间，韩国大学医学中心对43例肢体STS患者进行了保守手术及术后放疗。放疗总剂量中位数为60 Gy（范围50至74.4 Gy），7例患者接受了化疗。
中位随访期为70个月（范围5至302个月）。12例患者（27.9%）疾病复发。3例患者（7.0%）发生局部复发，10例患者（23.3%）出现远处转移。5年总生存率（OS）为69.2%，无病生存率为67.9%。5年局部无复发生存率为90.7%，远处无复发生存率为73.3%。单因素分析显示，无显著预后因素与局部复发的发生相关。组织学分级（p = 0.005）和分期（p = 0.02）影响远处转移的发生。单因素和多因素分析显示，组织学分级是OS唯一显著的预后因素。6例患者（14.0%）出现严重的急性治疗相关并发症，按照不良事件通用术语标准（CTCAE）为3或4级，2例患者（4.7%）出现严重的晚期并发症。
保守手术联合术后放疗在肢体STS中实现了令人满意的局部控制率，并发症发生率可接受。大多数失败为远处转移，与肿瘤分级和分期相关。大多数局部复发发生在放疗野内。可考虑选择性提高放疗剂量或开发有效的全身治疗方法。
