Division of Surgical Oncology, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina.
J Surg Res. 2013 Nov;185(1):245-9. doi: 10.1016/j.jss.2013.05.015. Epub 2013 May 29.
Local recurrence (LR) rates in patients with retroperitoneal sarcoma (RPS) are high, ranging from 40% to 80%, with no definitive studies describing the best way to administer radiation. Intraoperative electron beam radiation therapy (IOERT) provides a theoretical advantage for access to the tumor bed with reduced toxicity to surrounding structures. The goal of this study was to evaluate the role of IOERT in high-risk patients.
An institutional review board approved, single institution sarcoma database was queried to identify patients who received IOERT for treatment of RPS from 2/2001 to 1/2009. Data were analyzed using the Kaplan-Meier method, Cox regression, and Fisher Exact tests.
Eighteen patients (median age 51 y, 25-76 y) underwent tumor resection with IOERT (median dose 1250 cGy) for primary (n = 13) and recurrent (n = 5) RPS. Seventeen patients received neoadjuvant radiotherapy. Eight high-grade and 10 low-grade tumors were identified. Median tumor size was 15 cm. Four patients died and two in the perioperative period. Median follow-up of survivors was 3.6 y. Five patients (31%) developed an LR in the irradiated field. Three patients with primary disease (25%) and two (50%) with recurrent disease developed an LR (P = 0.5). Four patients with high-grade tumors (57%) and one with a low-grade tumor (11%) developed an LR (P = 0.1). The 2- and 5-y OS rates were 100% and 72%. Two- and 5-y LR rates were 13% and 36%.
Using a multidisciplinary approach, we have achieved low LR rates in our high-risk patient population indicating that IOERT may play an important role in managing these patients.
腹膜后肉瘤（RPS）患者的局部复发（LR）率较高，范围为 40%至 80%，尚无明确研究描述最佳的放疗方法。术中电子束放疗（IOERT）为进入肿瘤床提供了理论优势，同时减少了对周围结构的毒性。本研究的目的是评估 IOERT 在高危患者中的作用。
机构审查委员会批准后，对 2001 年 2 月至 2009 年 1 月期间接受 IOERT 治疗 RPS 的患者进行了单机构肉瘤数据库查询。使用 Kaplan-Meier 方法、Cox 回归和 Fisher 精确检验对数据进行分析。
18 例患者（中位年龄 51 岁，25-76 岁）接受了 IOERT（中位剂量 1250 cGy）治疗原发性（n = 13）和复发性（n = 5）RPS。17 例患者接受了新辅助放疗。有 8 例高级别和 10 例低级别肿瘤。肿瘤大小中位数为 15 cm。4 例患者死亡，2 例患者在围手术期死亡。幸存者的中位随访时间为 3.6 年。5 例患者（31%）在照射野中发生 LR。3 例原发性疾病患者（25%）和 2 例复发性疾病患者（50%）发生 LR（P = 0.5）。4 例高级别肿瘤患者（57%）和 1 例低级别肿瘤患者（11%）发生 LR（P = 0.1）。2 年和 5 年 OS 率分别为 100%和 72%。2 年和 5 年 LR 率分别为 13%和 36%。
采用多学科方法，我们在高危患者人群中实现了较低的 LR 率，表明 IOERT 可能在治疗这些患者中发挥重要作用。
