Kawaguchi N, Matsumoto S, Manabe J, Kuroda H, Sawaizumi M, Foruya K, Isobe Y
Dept. of Orthopedics, Cancer Institute Hospital, Japanese Foundation for Cancer Research.
Gan To Kagaku Ryoho. 1990 Feb;17(2):189-97.
Preoperative therapy effects, resected margin and local radicality were investigated in 40 cases of soft tissue sarcoma in which preoperative therapy (mainly radiation therapy) had been given. The results indicated that there was no effect upon prognosis due to postponement of surgery in order to perform preoperative treatment. In cases in which radiation therapy was used for preoperative treatment, even when a surgical margin resulted with in a tumor, no recurrence was found. However, histologically there was concern that some portion of the living tumor cell in marginal area of the tumor might have remained. Thus, at the present stage in cases having undergone initial treatment, radiation limited to the specific area of the resected margin causing non-curative margin should be given. If combined with preoperative radiation therapy, surgical intervention involving "wide margin" can be considered radical. On the other hand, cases having undergone surgery before and receiving preoperative therapy that show good response nevertheless show numerous recurrences. These recurrences, however, invariably occur outside of the irradiated area, and may be attributed to the fact that tumor cell dissemination from the earlier surgery was not within the radiation field. Hence, it was considered that the area for radiation in the case of a recurrence should extend well beyond the scar area.
对40例接受过术前治疗（主要是放射治疗）的软组织肉瘤患者，研究了术前治疗效果、手术切缘及局部根治性情况。结果表明，为进行术前治疗而推迟手术对预后没有影响。在术前采用放射治疗的病例中，即使手术切缘位于肿瘤内部，也未发现复发。然而，从组织学角度看，担心肿瘤边缘区域仍可能残留部分存活的肿瘤细胞。因此，在现阶段，对于接受过初始治疗的病例，应给予局限于导致切缘不彻底的手术切缘特定区域的放射治疗。如果联合术前放射治疗，涉及“广泛切缘”的手术干预可视为根治性手术。另一方面，术前已接受手术且术前治疗反应良好的病例仍有大量复发。然而，这些复发总是发生在照射区域之外，可能是因为早期手术的肿瘤细胞播散不在放射野内。因此，认为复发时的放射区域应远远超出瘢痕区域。
