Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Eur J Surg Oncol. 2020 May;46(5):905-913. doi: 10.1016/j.ejso.2019.12.014. Epub 2019 Dec 17.
In retroperitoneal soft tissue sarcoma (STS) local recurrence (LR) rates remain high despite more aggressive surgical approaches. Since wide resection margins cannot be achieved in all patients, application of intraoperative radiation therapy (IORT) has been frequently discussed. Still, the significance of IORT in multimodal treatment of retroperitoneal STS remains unclear.
Patients undergoing resection of primary or recurrent retroperitoneal STS at the University of Heidelberg Department of General, Visceral and Transplantation Surgery were retrospectively analyzed. Univariate Kaplan-Meyer and multivariate Cox regression analyses were performed to identify predictors of LR-free survival and to investigate the impact of IORT and high cumulative radiation doses. Analyses with propensity-score matched subgroups for IORT and cumulative radiation dose were performed to control for selection bias. Subgroup analyses for patients with retroperitoneal liposarcoma were likewise performed.
272 patients were identified. Recurrent tumors, histology of dedifferentiated liposarcoma or unclassified sarcoma and microscopically incomplete resection were associated with decreased LR-free survival. In liposarcoma, only recurrent and dedifferentiated tumors were confirmed as poor prognostic factors concerning LR. IORT and cumulative radiation doses exceeding 60 Gy did not influence LR rates (estimated 5-year LR-free survival: IORT: 39%, non-IORT: 46%; p = 0.79).
In this retrospective evaluation, additional application of IORT does not significantly influence oncological outcome in retroperitoneal soft tissue sarcoma. Randomized trials are needed to clarify the benefit of IORT.
尽管采用了更积极的手术方法，腹膜后软组织肉瘤（STS）的局部复发（LR）率仍然很高。由于并非所有患者都能达到广泛的切除边缘，因此经常讨论应用术中放射治疗（IORT）。尽管如此，IORT 在腹膜后 STS 的多模式治疗中的意义仍不清楚。
回顾性分析了海德堡大学普通、内脏和移植外科系接受原发性或复发性腹膜后 STS 切除术的患者。进行单变量 Kaplan-Meier 和多变量 Cox 回归分析，以确定 LR 无复发生存的预测因素，并研究 IORT 和高累积辐射剂量的影响。对 IORT 和累积辐射剂量进行倾向评分匹配亚组分析，以控制选择偏倚。对腹膜后脂肪肉瘤患者也进行了亚组分析。
共确定了 272 名患者。复发性肿瘤、去分化脂肪肉瘤的组织学或未分类肉瘤以及显微镜下不完全切除与 LR 无复发生存率降低相关。在脂肪肉瘤中，只有复发性和去分化肿瘤被证实是 LR 的不良预后因素。IORT 和累积辐射剂量超过 60Gy 不会影响 LR 率（估计 5 年 LR 无复发生存率：IORT：39%，非 IORT：46%；p=0.79）。
在这项回顾性评估中，额外应用 IORT 并不会显著影响腹膜后软组织肉瘤的肿瘤学结果。需要进行随机试验来阐明 IORT 的益处。
