Departments of Radiation Oncology.
Orthopedic Surgery.
Am J Clin Oncol. 2021 Jan 1;44(1):24-31. doi: 10.1097/COC.0000000000000772.
Neoadjuvant chemoradiation (NA-CRT), followed by resection of high-risk soft tissue sarcoma (STS), may offer good disease control and toxicity outcomes. We report on a single institution's modern NA-CRT experience.
Delay to surgical resection, resection margin status, extent of necrosis, tumor cell viability, presence of hyalinization, positron emission tomography (PET)/computed tomography data, and treatment toxicities were collected. Using the Kaplan-Meier survival analysis, 5-year overall survival, disease-free survival, distant metastasis-free survival, and local control (LC) were estimated. Clinicopathologic features and PET/computed tomography avidity changes were assessed for their potential predictive impact using the log-rank test.
From 2011 to 2018, 37 consecutive cases of localized high-risk STS were identified. Twenty-nine patients underwent ifosfamide-based NA-CRT to a median dose of 50 Gy before en bloc resection. At a median follow-up of 40.3 months, estimated 5-year overall survival was 86.1%, disease-free survival 70.2%, distant metastasis-free survival 75.2%, and LC 86.7%. Following NA-CRT, a median reduction of 54.7% was observed in tumor PET avidity; once resected, median tumor necrosis of 60.0% with no viable tumor cells was detected in 13.8% of the cases. Posttreatment resection margins were negative in all patients, with 27.6% having a margin of ≤1 mm. Delays of over 6 weeks following the end of radiation treatment to surgical resection occurred in 20.7% cases and was suggestive of inferior LC (92.8% vs. 68.6%, P=0.025).
This single-institution series of NA-CRT demonstrates favorable disease control. Delay in surgical resection was associated with inferior LC, a finding that deserves further evaluation in a larger cohort.
Level III-retrospective cohort study.
新辅助放化疗（NA-CRT）后行高风险软组织肉瘤（STS）切除术，可能具有良好的疾病控制和毒性作用。我们报告了一家机构的现代 NA-CRT 经验。
收集手术切除延迟、切缘状态、坏死程度、肿瘤细胞活力、玻璃样变性存在、正电子发射断层扫描（PET）/计算机断层扫描数据以及治疗毒性等信息。采用 Kaplan-Meier 生存分析估计 5 年总生存率、无病生存率、远处无转移生存率和局部控制率（LC）。采用对数秩检验评估临床病理特征和 PET/计算机断层扫描摄取变化对潜在预测影响。
2011 年至 2018 年，共确定 37 例局部高风险 STS 连续病例。29 例患者接受异环磷酰胺为基础的 NA-CRT，中位剂量为 50Gy，然后进行整块切除。中位随访 40.3 个月，估计 5 年总生存率为 86.1%，无病生存率为 70.2%，远处无转移生存率为 75.2%，LC 为 86.7%。NA-CRT 后，肿瘤 PET 摄取率中位数降低了 54.7%；一旦切除，13.8%的病例中检测到肿瘤坏死中位数为 60.0%，无存活肿瘤细胞。所有患者的术后切缘均为阴性，27.6%的患者切缘≤1mm。放疗结束后至手术切除的延迟超过 6 周的患者占 20.7%，提示 LC 较差（92.8%比 68.6%，P=0.025）。
本机构的 NA-CRT 系列研究显示出良好的疾病控制。手术切除延迟与 LC 较差相关，这一发现值得在更大的队列中进一步评估。
III 级回顾性队列研究。
