Departments of Radiation Oncology.
Orthopaedics and Rehabilitation.
Am J Clin Oncol. 2019 May;42(5):421-425. doi: 10.1097/COC.0000000000000532.
PURPOSE/OBJECTIVES: To report prognostic factors and long-term outcomes in adults with Ewing sarcoma treated with definitive radiotherapy.
We reviewed patients 18 years old and above with nonmetastatic Ewing sarcoma treated with radiotherapy +/- chemotherapy or surgery. Outcomes were stratified by age (30 and above vs. younger than 30 y), soft tissue extension, tumor size (≥8.5 vs. <8.5 cm), tumor location, resection (yes vs. no), and treatment era (1970-1992 vs. 1993-2012). Toxicities were scored using the RTOG criteria.
Fifty-five patients (21 women) were treated with radiotherapy. Average age at diagnosis: 26.7 years (38 patients below 30 vs. 17 patients 30 y and above). A total of 43 had soft tissue extension (78%). Median tumor size: 8.5 cm. Most tumors were in the pelvis (40%), followed by the lower (27%) and upper (24%) extremities. All but 1 patient received chemotherapy; 13 underwent resection. Median dose: 55 Gy. Median follow-up: 3.6 years; 17.5 years for living patients. The 5-year overall (OS) and cause-specific survival (CSS) rates were both 46%. OS and CSS rates were unaffected by age (P=0.97), tumor size (P=0.12), or tumor location (P=0.99). Soft tissue extension portended a significantly poorer prognosis for 5-year OS and CSS: 37% vs. 82% (with and without, respectively; P=0.04). Patients who underwent resection had improved 5-year OS and CSS: 77% vs. 37%, respectively (P=0.01). Patients treated after 1993 had improved 5-year OS: 58% vs. 37% (P=0.0264).
Adult patients with Ewing sarcoma experience similar treatment outcomes regardless of age at diagnosis. Soft tissue extension represents a poor prognostic factor. Aggressive trimodality therapy achieved the highest OS and CSS.
报告接受确定性放疗的成人尤文肉瘤患者的预后因素和长期结果。
我们回顾了年龄在 18 岁及以上、接受放疗+/-化疗或手术治疗的非转移性尤文肉瘤患者。根据年龄（30 岁及以上与<30 岁）、软组织延伸、肿瘤大小（≥8.5cm 与<8.5cm）、肿瘤位置、切除（是与否）以及治疗时代（1970-1992 年与 1993-2012 年）对结果进行分层。使用 RTOG 标准对毒性进行评分。
55 名患者（21 名女性）接受了放疗。诊断时的平均年龄为 26.7 岁（38 名<30 岁与 17 名≥30 岁）。共有 43 例存在软组织延伸（78%）。中位肿瘤大小为 8.5cm。大多数肿瘤位于骨盆（40%），其次是下肢（27%）和上肢（24%）。除 1 例患者外，所有患者均接受了化疗；13 例患者接受了切除。中位剂量为 55Gy。中位随访时间为 3.6 年；生存患者的随访时间为 17.5 年。5 年总生存率（OS）和疾病特异性生存率（CSS）均为 46%。年龄（P=0.97）、肿瘤大小（P=0.12）或肿瘤位置（P=0.99）对 OS 和 CSS 均无影响。软组织延伸预示着 5 年 OS 和 CSS 显著较差：分别为 37%和 82%（有和无软组织延伸，P=0.04）。接受切除的患者具有改善的 5 年 OS 和 CSS：分别为 77%和 37%（P=0.01）。1993 年后接受治疗的患者 5 年 OS 得到改善：58%比 37%（P=0.0264）。
成人尤文肉瘤患者无论诊断时的年龄如何，其治疗结果均相似。软组织延伸是预后不良的因素。积极的三联疗法可获得最高的 OS 和 CSS。
