Sherman N E, Romsdahl M, Evans H, Zagars G, Oswald M J
Department of Clinical Radiotherapy, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Int J Radiat Oncol Biol Phys. 1990 Jul;19(1):37-40. doi: 10.1016/0360-3016(90)90131-3.
From 1964 through 1984, 45 patients were referred for radiation therapy for desmoid tumor. Fourteen patients had inoperable lesions, or gross residual disease after incomplete resection. Thirty-one patients received postoperative XRT for positive margins or concern about the adequacy of the margin. The minimum follow-up was 2 years, maximum 22 years, median 7.6 years. No patient was lost to follow-up. The primary site was head and neck in 5, upper extremity in 10, chest wall and back in 8, abdomen 2, pelvis 4, and lower extremity 16. All patients were treated with megavoltage radiation therapy using shrinking field techniques. Large fields received a median dose of 50 Gy in 25 fractions. Boost fields were used in the majority of patients to deliver an additional dose of 7 to 27 Gy. The range of total doses was 50 to 76.2 Gy. Three patients received a boost with neutrons. Analysis of patients with inoperable or gross residual showed tumor control in 10 of 14 with a median follow-up of 9.4 years. Resolution of gross disease occurred at a range of 1/2 to 64.3 months with a median of 9 months. There was no evidence of a higher probability of ultimate control at higher doses. Tumor control was equal for men and women. The ten patients with local control had doses from 50 to 76.2 Gy whereas the four patients with in field failures had tumor doses of 57 to 66.4 Gy. There was no difference in median dose for patients with local control (60.3 Gy) versus those with tumor recurrence (60 Gy). For subclinical disease, 31 patients receiving postoperative or preoperative XRT had a 77 percent probability of local control in spite of the history of multiple tumor recurrences; local control was achieved in 8 of 9 with negative or uncertain margins and 16 of 22 with positive margins. An analysis of local control as a function of the number of operations revealed that patients referred for adjuvant radiotherapy with no more than two operative procedures had an 88 percent probability of local control, versus 66 percent for more than two operative procedures. All grade 3 complications (defined as requiring surgical intervention or prolonged hospitalization) occurred with doses above 60 Gy. Management of recurrences was successful in 8 of the 11 patients and no patient has died of tumor.(ABSTRACT TRUNCATED AT 400 WORDS)
1964年至1984年期间，45例患者因韧带样瘤被转诊接受放射治疗。14例患者存在无法手术切除的病变，或在不完全切除后有肉眼可见的残留病灶。31例患者因切缘阳性或担心切缘不充分而接受术后放疗。最短随访时间为2年，最长为22年，中位随访时间为7.6年。无患者失访。原发部位为头颈部5例，上肢10例，胸壁和背部8例，腹部2例，骨盆4例，下肢16例。所有患者均采用缩野技术进行兆伏级放射治疗。大野中位剂量为50 Gy，分25次给予。大多数患者使用加量野额外给予7至27 Gy剂量。总剂量范围为50至76.2 Gy。3例患者接受了中子加量治疗。对无法手术切除或有肉眼可见残留病灶的患者分析显示，14例中有10例肿瘤得到控制，中位随访时间为9.4年。肉眼可见病灶消退时间为0.5至64.3个月，中位时间为9个月。没有证据表明高剂量时最终控制的概率更高。男性和女性的肿瘤控制情况相同。10例局部控制的患者剂量为50至76.2 Gy，而4例野内复发的患者肿瘤剂量为57至66.4 Gy。局部控制患者的中位剂量（60.3 Gy）与肿瘤复发患者的中位剂量（60 Gy）无差异。对于亚临床疾病，31例接受术后或术前放疗的患者尽管有多次肿瘤复发史，但局部控制概率为77%；切缘阴性或不确定的9例中有8例实现局部控制，切缘阳性的22例中有16例实现局部控制。对局部控制与手术次数关系的分析显示，接受辅助放疗且手术次数不超过两次的患者局部控制概率为88%，而手术次数超过两次的患者为66%。所有3级并发症（定义为需要手术干预或延长住院时间）均发生在剂量超过6 Gy时。11例复发患者中有8例复发处理成功，无患者死于肿瘤。（摘要截断于400字）
