Gui Chengcheng, Morris Carol D, Meyer Christian F, Levin Adam S, Frassica Deborah A, Deville Curtiland, Terezakis Stephanie A
Department of Radiation Oncology and Molecular Radiation Sciences, Oncology, Johns Hopkins University, Baltimore, MD, USA.
Department of Orthopaedic Surgery, Oncology, Johns Hopkins University, Baltimore, MD, USA.
Radiat Oncol J. 2019 Jun;37(2):117-126. doi: 10.3857/roj.2018.00549. Epub 2019 Mar 28.
The purpose of this study was to characterize and evaluate the clinical significance of volume changes of soft tissue sarcomas during radiation therapy (RT), prior to definitive surgical resection.
Patients with extremity or pelvis soft tissue sarcomas treated at our institution from 2013 to 2016 with RT prior to resection were identified retrospectively. Tumor volumes were measured using cone-beam computed tomography obtained daily during RT. Linear regression evaluated the linearity of volume changes. Kruskal-Wallis tests, Mann-Whitney U tests, and linear regression evaluated predictors of volume change. Logistic and Cox regression evaluated volume change as a predictor of resection margin status, histologic treatment response, and tumor recurrence.
Thirty-three patients were evaluated. Twenty-nine tumors were high grade. Prior to RT, median tumor volume was 189 mL (range, 7.2 to 4,885 mL). Sixteen tumors demonstrated significant linear volume changes during RT. Of these, 5 tumors increased and 11 decreased in volume. Myxoid liposarcoma (n = 5, 15%) predicted decreasing tumor volume (p = 0.0002). Sequential chemoradiation (n = 4, 12%) predicted increasing tumor volume (p = 0.008) and corresponded to longer times from diagnosis to RT (p = 0.01). Resection margins were positive in three cases. Five patients experienced local recurrence, and 7 experienced distant recurrence, at median 8.9 and 6.9 months post-resection, respectively. Volume changes did not predict resection margin status, local recurrence, or distant recurrence.
Volume changes of pelvis and extremity soft tissue sarcomas followed linear trends during RT. Volume changes reflected histologic subtype and treatment characteristics but did not predict margin status or recurrence after resection.
本研究旨在明确并评估在确定性手术切除之前，软组织肉瘤在放射治疗（RT）期间体积变化的特征及其临床意义。
对2013年至2016年在我院接受切除术前放疗的四肢或骨盆软组织肉瘤患者进行回顾性分析。在放疗期间每日使用锥形束计算机断层扫描测量肿瘤体积。线性回归评估体积变化的线性。Kruskal-Wallis检验、Mann-Whitney U检验和线性回归评估体积变化的预测因素。逻辑回归和Cox回归评估体积变化作为切除边缘状态、组织学治疗反应和肿瘤复发的预测因素。
共评估了33例患者。29个肿瘤为高级别。放疗前，肿瘤体积中位数为189 mL（范围7.2至4885 mL）。16个肿瘤在放疗期间显示出显著的线性体积变化。其中，5个肿瘤体积增大，11个肿瘤体积减小。黏液样脂肪肉瘤（n = 5，15%）预示肿瘤体积减小（p = 0.0002）。序贯放化疗（n = 4，12%）预示肿瘤体积增大（p = 0.008），且与从诊断到放疗的时间较长相关（p = 0.01）。3例患者的切除边缘为阳性。5例患者发生局部复发，7例患者发生远处复发，分别在切除术后中位8.9个月和6.9个月。体积变化不能预测切除边缘状态、局部复发或远处复发。
骨盆和四肢软组织肉瘤在放疗期间的体积变化呈线性趋势。体积变化反映了组织学亚型和治疗特征，但不能预测切除后的边缘状态或复发情况。
