新辅助治疗的放射学反应及其对 IIB/III 期软组织肉瘤手术范围和预后的影响。

Radiographic response to neoadjuvant therapy and its impact on scope of surgery and prognosis in stage IIB/III soft tissue sarcomas.

机构信息

Department of Gastric Cancer and Soft Tissue Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, China.

出版信息

BMC Cancer. 2013 Dec 11;13:591. doi: 10.1186/1471-2407-13-591.

DOI:10.1186/1471-2407-13-591

PMID:24325569

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4028883/

Abstract

BACKGROUND

Neoadjuvant chemoradiotherapy has been newly included in the NCCN guidelines as a treatment option for stage IIB/III soft tissue sarcomas. Whether radiographic response to neoadjuvant therapy correlates with improved quality of resection and prognosis remains unproven.

METHODS

Data from 120 consecutive patients who were treated with neoadjuvant chemoradiotherapy followed by surgical resection for their locally aggressive limb sarcomas were retrospectively reviewed. Radiographic response was evaluated after neoadjuvant therapy according to Response Evaluation Criteria In Solid Tumors, and data was analyzed for overall survival (OS), local recurrence free survival (LRFS) and metastasis free survival (MFS). Surgical complications and toxicities, as well as functional outcomes, were also analysed.

RESULTS

After neoadjuvant chemoradiotherapy, 25 patients (20.8%) had a partial response, 75 patients (62.5%) had stable disease, and 20 patients (16.7%) showed disease progression. Radiographic response to neoadjuvant therapy correlated significantly with improved OS (P = 0.002) and MFS (P < 0.001). Patients with partial response (PR) had a significantly decreased rate of R2 resection as compared with stable disease (SD) and progressive disease (PD) patients (4.0% Vs 21.4%, P < 0.001).

CONCLUSIONS

Radiographic response to neoadjuvant chemoradiotherapy correlates with improved quality of resection and prognosis in extremity STS patients.

摘要

背景

新辅助放化疗已被纳入 NCCN 指南，作为 IIB/III 期软组织肉瘤的治疗选择。新辅助治疗的影像学反应是否与改善切除质量和预后相关仍未得到证实。

方法

回顾性分析了 120 例连续接受新辅助放化疗后行手术切除局部侵袭性肢体肉瘤的患者的数据。根据实体瘤反应评价标准（Response Evaluation Criteria In Solid Tumors）评估新辅助治疗后的影像学反应，并分析总生存期（Overall Survival，OS）、无局部复发生存期（Local Recurrence Free Survival，LRFS）和无转移生存期（Metastasis Free Survival，MFS）。还分析了手术并发症和毒性以及功能结果。

结果

新辅助放化疗后，25 例（20.8%）患者部分缓解，75 例（62.5%）患者病情稳定，20 例（16.7%）患者病情进展。新辅助治疗的影像学反应与改善的 OS（P=0.002）和 MFS（P<0.001）显著相关。与疾病稳定（SD）和进展（PD）患者相比，部分缓解（PR）患者的 R2 切除率显著降低（4.0% vs 21.4%，P<0.001）。