Department of Radiation Oncology, University Medical Center, Bonn, Germany.
Internal Medicine Oncology, Hematology and Rheumatology, University Medical Center, Bonn, Germany.
J Cancer Res Clin Oncol. 2023 Jul;149(8):4877-4888. doi: 10.1007/s00432-022-04423-1. Epub 2022 Oct 26.
Over the years, radiotherapy has been established as a tool to improve local control for high-grade sarcomas. Although the European Society for Medical Oncology guidelines has taken notice of a shift toward a neoadjuvant radiotherapy approach, the American Society for Radiation Oncology guidelines clearly favor a neoadjuvant approach, citing debilitating long-term adverse effects when radiotherapy is applied postoperatively. In this study, we examined these irradiation-associated adverse events for adjuvant radiotherapy and focused on the prognostic factors for disease outcome, including local control.
In this retrospective study, data for 106 patients with extremity soft-tissue sarcomas diagnosed between 1997 and 2021, of which 40 received adjuvant radiotherapy, were collected from the clinical and radiological information systems of a high-volume sarcoma treatment center. These data were then analyzed for radiation-associated side effects as well as predictive factors for overall survival, disease-free survival, local control, and surgical complications.
Radiotherapy was beneficial to patients improving local control, especially for high-grade sarcomas, even when those were resected with negative margins. Side effects due to radiotherapy occurred in 87.5% of the patients, and these effects primarily included radiation dermatitis in 67.5%; however, only 40.0% had any adverse event of ≥ grade 2 according to Common Terminology Criteria for Adverse Events. Long-term function-limiting side effects occurred in 45.0% of the patients; 10% exhibited ≥ grade 2 function-limiting adverse events. Greater time between surgery and adjuvant radiotherapy was beneficial for the patients, whereas joint infiltrating sarcomas were associated with more severe long term, function-limiting adverse events. 28.3% of the patients experienced a recurrence at any location (median time 18.35 months) and in 16% the recurrence was local (median time 16.11 months), resulting in 1, 3, and 5 year disease-free survival rates of 74.1, 58.9, and 38.5% and local control rates of 78.7, 61.6, and 42.8% were observed, respectively.
Recurrences may be avoided with high-dose radiation, especially for high-grade G2 and G3 sarcomas, even after complete R0 resection. This resulted in a low rate of severe long-term function-limiting adverse events. Thus, adjuvant radiotherapy should be seriously considered when planning patient treatment, especially when treating patients that present with high-grade sarcomas.
多年来，放疗已被确立为提高高级别肉瘤局部控制的工具。尽管欧洲肿瘤内科学会指南已经注意到向新辅助放疗方法的转变，但美国放射肿瘤学会指南明确倾向于新辅助方法，因为当放疗在术后应用时会产生长期的致残性不良影响。在这项研究中，我们检查了辅助放疗相关的照射不良事件，并重点研究了疾病结果的预后因素，包括局部控制。
在这项回顾性研究中，从一个高容量肉瘤治疗中心的临床和放射信息系统中收集了 1997 年至 2021 年间诊断的 106 例肢体软组织肉瘤患者的数据，其中 40 例接受了辅助放疗。然后对这些与放疗相关的副作用以及与总生存率、无病生存率、局部控制率和手术并发症相关的预测因素进行了分析。
放疗对提高局部控制率有益，特别是对于高级别肉瘤，即使这些肉瘤是在切缘阴性的情况下切除的。87.5%的患者发生了放疗相关的副作用，这些副作用主要包括 67.5%的放射性皮炎；然而，只有 40.0%的患者根据常见不良事件术语标准发生了任何≥2 级的不良事件。45.0%的患者发生了长期的功能受限的副作用；10%的患者发生了≥2 级的功能受限不良事件。手术和辅助放疗之间的时间间隔越大对患者越有利，而关节浸润性肉瘤与更严重的长期功能受限不良事件有关。28.3%的患者在任何部位（中位时间 18.35 个月）复发，16%的患者局部复发（中位时间 16.11 个月），分别导致 1、3 和 5 年无病生存率为 74.1%、58.9%和 38.5%，局部控制率为 78.7%、61.6%和 42.8%。
高剂量放疗可避免复发，特别是对于高级别 G2 和 G3 肉瘤，即使在完全 R0 切除后也是如此。这导致严重的长期功能受限不良事件发生率较低。因此，在制定患者治疗计划时应认真考虑辅助放疗，特别是在治疗高级别肉瘤患者时。
