Cerda T, Martin É, Truc G, Créhange G, Maingon P
Department of Radiation Oncology, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France.
Cancer Radiother. 2017 Feb;21(1):16-20. doi: 10.1016/j.canrad.2016.07.102. Epub 2016 Dec 29.
Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas.
Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy were: R1 status after initial surgery, R1 status after wide en bloc resection and orchiectomy, high French federation of cancer centers (FNCLCC) grade, tumor size over 5cm, tumor resection during surgery.
Median age at diagnosis was 66years (range 46-84years). Median follow-up was 18months (range 6-28months). Four patients had repeat surgery after incomplete removal. All surgeries were orchidectomy with primary ligation of testicular vessels. One patient did not have an in sano margin after the second surgical procedure. The median tumor size was 60mm (range 30-150mm). No recurrence was observed during the follow-up.
No grade 4 toxicities were reported and the most frequent acute toxicity was dermatitis. No recurrence was reported after adjuvant intensity-modulated radiotherapy. The treatment is feasible and well tolerated and seems to provide encouraging results regarding locoregional control of the disease. Dynamic or rotational intensity-modulated radiotherapy is now recommended to decrease acute toxicities while improving the efficacy of this approach.
精索肉瘤是一种罕见疾病，由于缺乏相关指南，其治疗仍存在争议。标准治疗方法是手术：广泛软组织切除联合根治性腹股沟睾丸切除术，诊断在标本分析时做出。局部复发率高提示需对瘤床进行辅助放疗。本系列研究的目的是确定术后调强放疗治疗精索肉瘤的疗效和安全性。
我们的系列研究纳入了2011年至2014年间连续治疗的5例精索肉瘤患者。放疗指征为：初次手术后R1状态、广泛整块切除及睾丸切除术后R1状态、法国癌症中心联合会（FNCLCC）分级高、肿瘤大小超过5cm、手术中肿瘤切除情况。
诊断时的中位年龄为66岁（范围46 - 84岁）。中位随访时间为18个月（范围6 - 28个月）。4例患者在切除不完全后进行了再次手术。所有手术均为睾丸切除术并结扎睾丸血管。1例患者在第二次手术后切缘不净。中位肿瘤大小为60mm（范围30 - 150mm）。随访期间未观察到复发。
未报告4级毒性反应，最常见的急性毒性反应为皮炎。辅助调强放疗后未报告复发。该治疗可行且耐受性良好，似乎在疾病的局部区域控制方面提供了令人鼓舞的结果。现推荐采用动态或旋转调强放疗以降低急性毒性反应，同时提高该方法的疗效。
