软组织肉瘤局部复发再探讨：是否有“选择性”放疗的作用？
Local Recurrence of Soft Tissue Sarcoma Revisited: Is there a Role for "Selective" Radiation?
机构信息
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
出版信息
Iowa Orthop J. 2022 Jun;42(1):239-248.
BACKGROUND
Radiation therapy (RT) is often utilized in cases of high-grade soft tissue sarcoma (STS), but there remain situations where treatment is with surgical excision alone. Our goals were to determine (1) the local recurrence (LR) rate with and without perioperative RT and (2) associations between local recurrence, patient, tumor, and treatment variables.
METHODS
We performed a retrospective review of 165 consecutive STS patients. A Cox proportional hazards model was used to investigate variables associated with local recurrence.
RESULTS
LR occurred in 15/78 (19%) without RT, 4/29 (14%) with postoperative RT, and 0/58 with preoperative RT (p=0.002). We found increased rates of local recurrence at 24 months for myxofibrosarcoma (p=0.001) and no-RT (p=0.003). Myxofibrosarcoma accounted for 33 (20%) of the study patients and 12 (63%) of the local recurrences.
CONCLUSION
The LR rate in patients treated with surgery alone was disproportionately attributable to myxofibrosarcoma (11/23 cases, 48%). Other subtypes demonstrated a lower rate of LR in the absence of RT (4/55 cases, 7%), and no LR occurred when final margins were >2 mm. In certain circumstances treatment with a negative margin surgical resection followed by close observation is justifiable. RT is effective and should continue to be considered routinely in myxofibrosarcoma or when surgical margins are inadequate. .
背景
放射治疗（RT）常用于高级别软组织肉瘤（STS），但仍存在单独手术切除的情况。我们的目标是确定（1）有无围手术期 RT 的局部复发（LR）率，以及（2）局部复发与患者、肿瘤和治疗变量之间的关系。
方法
我们对 165 例连续 STS 患者进行了回顾性研究。采用 Cox 比例风险模型研究与局部复发相关的变量。
结果
无 RT 的 78 例中有 15 例（19%）发生 LR，术后 RT 的 29 例中有 4 例（14%）发生 LR，术前 RT 的 58 例中无 LR（p=0.002）。我们发现黏液纤维肉瘤（p=0.001）和无 RT （p=0.003）的 24 个月局部复发率增加。黏液纤维肉瘤占研究患者的 33 例（20%）和 12 例（63%）局部复发。
结论
单独手术治疗患者的 LR 率不成比例地归因于黏液纤维肉瘤（11/23 例，48%）。其他亚型在无 RT 的情况下 LR 率较低（4/55 例，7%），当最终切缘>2 mm 时无 LR。在某些情况下，行切缘阴性的手术切除后密切观察是合理的。RT 是有效的，应继续常规考虑在黏液纤维肉瘤或手术切缘不足时使用。
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