Patel Sagar A, Royce Trevor J, Barysauskas Constance M, Thornton Katherine A, Raut Chandrajit P, Baldini Elizabeth H
Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
Ann Surg Oncol. 2017 Jun;24(6):1588-1595. doi: 10.1245/s10434-016-5755-5. Epub 2017 Jan 5.
Optimal surveillance imaging (SI) regimens following radiation therapy (RT) and radical resection for localized soft tissue sarcoma (STS) are unknown and practice patterns vary.
Between 2006 and 2014, 94 patients with localized STS of the extremity/trunk treated with preoperative RT and radical resection were identified. Timing of local recurrence (LR), distant recurrence (DR), and SI were evaluated. The Kaplan-Meier method was used to determine recurrence-free and overall survival (OS), and the method of recurrence detection (SI or due to signs/symptoms) was determined.
Median tumor size was 7.5 cm, and 92% were intermediate/high grade. After a median follow-up of 60 months for surviving patients, 30 patients (32%) recurred, including 5 LRs and 26 DRs. The median time to LR and DR was 36.2 months (range 14.4-65.7) and 10.4 months (range 5.2-76.9), respectively, and the 5-year local recurrence-free survival (RFS), distant RFS, and OS was 95, 71, and 76%, respectively. Local SI was performed for 90% of patients, mostly by magnetic resonance imaging (MRI; 91%). Of the five LRs, two were detected by SI and three had signs/symptoms preceding imaging. All patients underwent distant SI. Of the 26 DRs, 23 (88%) were in the lung. SI detected 22 (85%) DRs, and only 4 of 26 had signs/symptoms prompting imaging.
Given excellent local control with RT and radical resection for intermediate/high-grade STS of the extremity/trunk, SI of the primary site should be reserved for select patients at high risk of LR. Conversely, due to frequent occurrence of asymptomatic DR in the lungs, periodic lung SI is appropriate. Routine abdominopelvic SI may not be indicated for most histologies.
对于局部软组织肉瘤（STS），放疗（RT）和根治性切除术后的最佳监测成像（SI）方案尚不明确，且实践模式各异。
2006年至2014年期间，共确定了94例接受术前放疗和根治性切除的四肢/躯干局部STS患者。评估局部复发（LR）、远处复发（DR）的时间以及SI情况。采用Kaplan-Meier法确定无复发生存期和总生存期（OS），并确定复发检测方法（SI或因体征/症状）。
肿瘤中位大小为7.5 cm，92%为中/高级别。存活患者中位随访60个月后，30例患者（32%）复发，包括5例LR和26例DR。LR和DR的中位时间分别为36.2个月（范围14.4 - 65.7）和10.4个月（范围5.2 - 76.9），5年局部无复发生存率（RFS）、远处RFS和OS分别为95%、71%和76%。90%的患者进行了局部SI，主要通过磁共振成像（MRI；91%）。在5例LR中，2例通过SI检测到，3例在成像前有体征/症状。所有患者均接受了远处SI。在26例DR中，23例（88%）发生在肺部。SI检测到22例（85%）DR，26例中只有4例有体征/症状促使进行成像。
鉴于放疗和根治性切除对四肢/躯干中/高级别STS具有良好的局部控制效果，原发部位的SI应仅用于有LR高风险的特定患者。相反，由于肺部无症状DR频繁发生，定期进行肺部SI是合适的。对于大多数组织学类型，可能无需常规进行腹盆腔SI。
