Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Pract Radiat Oncol. 2017 Nov-Dec;7(6):e507-e516. doi: 10.1016/j.prro.2017.04.010. Epub 2017 Apr 18.
The timing of perioperative radiation therapy (RT) in the treatment of soft tissue sarcoma (STS) varies among institutions. This study examines patterns of care, trends in utilization, and survival with preoperative versus postoperative RT for primary STS.
Using the National Cancer Data Base, we identified patients with stage I-III STS who underwent definitive surgery with either preoperative or postoperative RT between 2004 and 2012. Univariate, bivariate, and multivariate analyses were performed to identify factors predicting receipt of preoperative versus postoperative RT. Overall survival (OS) was analyzed using the log-rank test, Kaplan-Meier method, and Cox proportional-hazards model.
This study included 9604 patients: 7246 (75.4%) received postoperative and 2358 (24.6%)-preoperative RT. Chemotherapy was administered to 27.0% patients in the preoperative and 13.0% in the postoperative cohort. Use of preoperative RT increased over time, from 16.8% in 2004 to 29.7% in 2012. Multivariate analysis revealed that preoperative RT utilization increased with the following factors: higher educational attainment, treatment at an academic facility, further distance from facility (>60 miles), receipt of chemotherapy, tumor originating in lower extremities, >10 cm tumors, and myxoid liposarcoma. OS analysis revealed no difference between the 2 treatment cohorts.
Postoperative RT is used much more commonly than preoperative RT in localized STS; however, preoperative RT use has increased in recent years. Multiple demographic and clinicopathologic factors were predictive of preoperative RT use. Consistent with randomized phase 3 data, there was no difference in OS.
软组织肉瘤（STS）治疗中围手术期放疗（RT）的时机在不同机构之间存在差异。本研究旨在研究原发性 STS 术前与术后 RT 的治疗模式、应用趋势和生存情况。
本研究利用国家癌症数据库，纳入了 2004 年至 2012 年间接受明确手术治疗且术后接受或未接受 RT 的 I-III 期 STS 患者。采用单因素、双因素和多因素分析来确定预测接受术前与术后 RT 的因素。采用对数秩检验、Kaplan-Meier 法和 Cox 比例风险模型分析总生存率（OS）。
本研究共纳入 9604 例患者：7246 例（75.4%）接受术后 RT，2358 例（24.6%）接受术前 RT。术前组和术后组分别有 27.0%和 13.0%的患者接受化疗。术前 RT 的应用随着时间的推移而增加，从 2004 年的 16.8%增加到 2012 年的 29.7%。多因素分析显示，术前 RT 的应用与以下因素有关：较高的教育程度、在学术机构接受治疗、距离机构较远（>60 英里）、接受化疗、肿瘤起源于下肢、肿瘤直径>10cm、黏液样脂肪肉瘤。OS 分析显示两组间无差异。
在局限性 STS 中，术后 RT 的应用比术前 RT 更为常见；然而，近年来术前 RT 的应用有所增加。多种人口统计学和临床病理学因素与术前 RT 的应用相关。与随机 III 期研究数据一致，OS 无差异。
