Departments of Radiation Oncology.
Sarcoma Medical Oncology.
Am J Clin Oncol. 2019 Mar;42(3):238-242. doi: 10.1097/COC.0000000000000515.
We evaluated our experience treating patients with extraskeletal osteosarcoma (ESOS) using combined modality local therapy, including surgery and radiation therapy (RT), to investigate local control (LC) and other survival endpoints.
We reviewed the records of 21 consecutive patients with nonmetastatic, ESOS treated with RT in combination with surgery at our institution from 1984 to 2015. Postoperative RT was used for 10 patients (48%) to a median dose of 60 Gy (range, 60 to 68 Gy). The other 11 patients (52%) received 50 Gy preoperatively. Seven patients (33%) were treated with neoadjuvant or adjuvant chemotherapy. Among the patients who received chemotherapy, all were treated with doxorubicin and ifosfamide for a median of 6 cycles (range, 4 to 6).
Median follow-up time was 120 months (range, 6 to 200 mo). Larger tumor size (>5 cm) was associated with chemotherapy use (P=0.046). The 5-year LC, distant metastatic free survival, and disease-specific survival rates were 93%, 53%, and 62%, respectively. Only 1 patient (5%) had a local recurrence at 22 months. Nine patients (43%) developed distant metastases at a median time of 9 months (range, 1 to 30 mo) without any significant factors for reduced distant metastatic free survival. Following disease relapse, there were 2 patients who were ultimately salvaged, both of whom were treated with chemotherapy and surgery.
RT in combination with surgery provides favorable LC for patients with ESOS. However, patients have a high rate of distant metastases with limited salvage.
我们评估了采用手术联合放射治疗（RT）的综合局部治疗方法治疗非骨骼骨肉瘤（ESOS）患者的经验，以研究局部控制（LC）和其他生存终点。
我们回顾了 1984 年至 2015 年在我院接受手术联合 RT 治疗的 21 例非转移性 ESOS 患者的病历。10 例患者（48%）接受术后 RT，中位剂量为 60Gy（范围 60-68Gy）。其余 11 例患者（52%）接受术前 50Gy。7 例患者（33%）接受新辅助或辅助化疗。接受化疗的患者均接受多柔比星和顺铂治疗，中位疗程数为 6 个周期（范围 4-6 个周期）。
中位随访时间为 120 个月（范围 6-200 个月）。较大的肿瘤大小（>5cm）与化疗的使用相关（P=0.046）。5 年 LC、远处无转移生存和疾病特异性生存率分别为 93%、53%和 62%。仅有 1 例患者（5%）在 22 个月时出现局部复发。9 例患者（43%）在中位时间 9 个月（范围 1-30 个月）出现远处转移，远处无转移生存无明显降低的相关因素。疾病复发后，有 2 例患者最终得到挽救，均接受化疗和手术治疗。
手术联合 RT 为 ESOS 患者提供了良好的 LC。然而，患者远处转移率高，挽救有限。
