Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
Department of Medical Informatics, Biometry and Epidemiology-IBE, Research Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Ludwig Maximilian University, Munich, Germany.
Ann Surg Oncol. 2018 Mar;25(3):754-767. doi: 10.1245/s10434-017-6081-2. Epub 2017 Sep 11.
The aim of this study was to evaluate the role of preoperative and postoperative external beam radiation therapy (EBRT) in the treatment of resectable soft tissue sarcomas (STSs) of different tumor locations.
A systematic literature search was performed to identify studies investigating the effects of EBRT (versus no EBRT) on local recurrence (LR) and overall survival (OS) or comparing different EBRT sequences. Random effects meta-analyses were calculated and presented as cumulative odds ratios (ORs).
Sixteen studies (n = 3958 patients) comparing EBRT versus no EBRT, including one randomized controlled trial (RCT) in extremity sarcoma, were analyzed. EBRT appeared to reduce LR in both retroperitoneal tumors (OR 0.47, p < 0.0001) and other locations (OR 0.49, p = 0.001). OS was improved by EBRT in retroperitoneal STSs (OR 0.37, p < 0.0001) but not in other tumor locations. Eleven studies (n = 2140), including one RCT, compared preoperative and postoperative radiotherapy. LR was less frequent following preoperative EBRT in retroperitoneal STSs (OR 0.03, p = 0.02), as well as in other tumor locations (OR 0.67, p = 0.01), while wound complications in extremity sarcoma were more frequent following preoperative EBRT (OR 2.92, p < 0.0001). Several studies included in this meta-analysis bear a high risk of bias and no RCT has been published for retroperitoneal STS.
This meta-analysis supports the use of EBRT for local tumor control in patients with resectable STSs. Based on a small number of non-randomized studies, a positive effect on OS may exist in the subgroup of retroperitoneal STSs.
本研究旨在评估术前和术后外照射放疗（EBRT）在不同肿瘤部位可切除软组织肉瘤（STS）治疗中的作用。
进行了系统的文献检索，以确定研究 EBRT（与无 EBRT 相比）对局部复发（LR）和总生存（OS）的影响，或比较不同 EBRT 序列的研究。计算了随机效应荟萃分析，并以累积优势比（OR）表示。
分析了 16 项比较 EBRT 与无 EBRT 的研究（n=3958 例患者），其中包括一项四肢肉瘤的随机对照试验（RCT）。EBRT 似乎降低了腹膜后肿瘤（OR 0.47，p<0.0001）和其他部位（OR 0.49，p=0.001）的 LR。EBRT 改善了腹膜后 STS 的 OS（OR 0.37，p<0.0001），但对其他肿瘤部位没有影响。11 项研究（n=2140），包括一项 RCT，比较了术前和术后放疗。腹膜后 STS 中，术前 EBRT 后 LR 发生率较低（OR 0.03，p=0.02），其他肿瘤部位也较低（OR 0.67，p=0.01），但四肢肉瘤术前 EBRT 后伤口并发症更常见（OR 2.92，p<0.0001）。本荟萃分析中纳入的多项研究存在较高的偏倚风险，且尚未发表腹膜后 STS 的 RCT。
本荟萃分析支持在可切除 STS 患者中使用 EBRT 进行局部肿瘤控制。基于少数非随机研究，腹膜后 STS 亚组的 OS 可能存在积极影响。
