Tsagozis Panagiotis, Brosjö Otte, Skorpil Mikael
1Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden.
2Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Clin Sarcoma Res. 2018 Oct 5;8:19. doi: 10.1186/s13569-018-0106-x. eCollection 2018.
Preoperative radiotherapy is often used to facilitate excision of soft-tissue sarcomas. We aimed define factors that affect local tumour control and patient survival.
A single institution registry study of 89 patients with non-metastatic soft-tissue sarcomas having preoperative radiotherapy between 1994 and 2014. Radiologic (presence of peritumoural oedema and volume change following radiotherapy) and histopathologic (tumour volume, grade and surgical margin) parameters were recorded. Outcomes were the events of local recurrence, amputation, metastasis and death.
Local recurrence rate was low (12%) and marginal excision gave equal local control to wide excision. Pelvic localization was associated with a higher risk for amputation. The absence of peritumoural oedema on MRI defined a subgroup of tumours with more favourable oncologic outcome. Reduction of tumour volume following radiotherapy was also associated with better patient survival. Both these radiologic parameters were associated with lower tumour grade. Tumour necrosis was not significant for patient survival. The local complication rate, mainly wound healing problems and infection, was high (40%), but did not lead to any amputation.
Preoperative radiotherapy of high-risk soft-tissue sarcomas allows for good local control rate at the expense of local wound complications, which are however manageable. Marginal excision is sufficient for local control. Absence of peritumoural oedema on MRI, as well as tumour size reduction following radiotherapy are associated to superior patient survival and can be used ass early prognostic factors.
术前放疗常用于促进软组织肉瘤的切除。我们旨在确定影响局部肿瘤控制和患者生存的因素。
一项单机构登记研究，纳入了1994年至2014年间接受术前放疗的89例非转移性软组织肉瘤患者。记录放射学参数（肿瘤周围水肿的存在情况以及放疗后的体积变化）和组织病理学参数（肿瘤体积、分级和手术切缘）。观察指标为局部复发、截肢、转移和死亡事件。
局部复发率较低（12%），边缘切除与广泛切除的局部控制效果相当。盆腔部位的肿瘤截肢风险较高。MRI上无肿瘤周围水肿定义了一组肿瘤学预后更优的肿瘤亚组。放疗后肿瘤体积缩小也与患者更好的生存相关。这两个放射学参数均与较低的肿瘤分级相关。肿瘤坏死对患者生存无显著影响。局部并发症发生率较高（40%），主要是伤口愈合问题和感染，但未导致任何截肢。
高危软组织肉瘤的术前放疗可实现良好的局部控制率，但代价是局部伤口并发症，不过这些并发症是可控的。边缘切除足以实现局部控制。MRI上无肿瘤周围水肿以及放疗后肿瘤大小缩小与患者的较好生存相关，可作为早期预后因素。
