Levy A, Bonvalot S, Bellefqih S, Vilcot L, Rimareix F, Terrier P, Belemsagha D, Cascales A, Domont J, Mir O, Honoré C, Le Cesne A, Le Péchoux C
Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France.
Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Surgery, Gustave-Roussy, Villejuif, France.
Eur J Surg Oncol. 2014 Dec;40(12):1648-54. doi: 10.1016/j.ejso.2014.06.014. Epub 2014 Jul 25.
To evaluate the indications and results of preoperative radiotherapy (RT) on a series of selected patients treated at our institution with curative intent for a limb sarcoma (STS).
From 05/1993 to 12/2011, 64 STS patients received preoperative RT.
RT was delivered as a "limb salvage treatment" prior to surgery for the following reasons: as the preferential induction treatment in 53 patients (83%) or as a second intent (17%) after the failure of neoadjuvant systemic chemotherapy/isolated limb perfusion. Surgery was performed after RT in 54 (84%) patients and final limb salvage was performed in 98%. Musculo-cutaneous flap reconstruction was planned upfront in 44% patients, and 19% had a skin graft. Seven patients (13%) had a postoperative RT boost. Thirteen (20%) patients had grade (G) 3/4 adverse events, one after RT and 12 after surgery. At a median follow-up of 3.5 years, the 3-year actuarial overall survival (OS) and distant relapse (DR) rates were 83% and 31%, respectively. Two patients developed a local relapse and two a local progression (non-operated patients). In the multivariate analysis (MVA), histological subtype (leiomyosarcoma) and grade 3 were predictive of poorer survival. Patients with >3 month delay between the start of RT and surgery at our institution had an increased risk of DR in the MVA.
Induction RT should be personalised according to histological subtype, tumour site and risks-benefit ratio of preoperative radiotherapy and is best managed by a multidisciplinary surgical and oncology team in a specialist sarcoma centre.
评估在我院对一系列有治愈意向的肢体肉瘤（软组织肉瘤，STS）患者进行术前放疗（RT）的适应证及结果。
1993年5月至2011年12月，64例STS患者接受了术前放疗。
放疗作为“保肢治疗”在手术前进行，原因如下：53例患者（83%）作为优先诱导治疗，或在新辅助全身化疗/隔离肢体灌注失败后作为二线治疗（17%）。54例（84%）患者在放疗后进行了手术，98%患者最终实现了保肢。44%患者预先计划进行肌皮瓣重建，19%患者进行了植皮。7例患者（13%）术后进行了放疗增敏。13例（20%）患者出现3/4级不良事件，1例在放疗后，12例在手术后。中位随访3.5年时，3年精算总生存率（OS）和远处复发（DR）率分别为83%和31%。2例患者出现局部复发，2例出现局部进展（未手术患者）。在多因素分析（MVA）中，组织学亚型（平滑肌肉瘤）和3级是生存较差的预测因素。在我院放疗开始与手术之间延迟>3个月的患者在多因素分析中有更高的远处复发风险。
诱导放疗应根据组织学亚型、肿瘤部位以及术前放疗的风险效益比进行个体化，最好由肉瘤专科中心的多学科手术和肿瘤团队进行管理。
