Roohani Siyer, Ehret Felix, Kobus Marta, Flörcken Anne, Märdian Sven, Rau Daniel, Wittenberg Silvan, Jarosch Armin, Öllinger Robert, Zips Daniel, Kaul David
Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353 Berlin, Germany.
Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Adv Radiat Oncol. 2023 Mar 27;8(4):101224. doi: 10.1016/j.adro.2023.101224. eCollection 2023 Jul-Aug.
Radiotherapy (RT) is a mainstay of treatment for high-grade soft tissue sarcomas (STS). We sought to examine the pattern of local recurrence (LR) with regard to target volume, clinical course, and tumor characteristics in extremity and trunk wall STS patients receiving pre- or postoperative RT.
In this retrospective study, LR rates and patterns in 91 adult patients with a primary diagnosis of localized high-grade STS of the extremities and trunk wall treated with pre- or postoperative RT at our institution between 2004 and 2021 were analyzed. Radiation treatment plans and imaging data sets at diagnosis and LR were compared.
Seventeen out of 91 (18.7 %) patients developed a LR after a median time of 12.7 months. In 10 out of 13 LRs (76.9%) with available treatment plans and radiographic imaging data at the time of recurrence, the LR occurred within the planned target volume (PTV), 2 LRs were marginal (15.4%, at the edge of the PTV volume), and one relapsed out-of-field (7.7%, outside the PTV volume). Positive surgical margins (microscopic or macroscopic) were found in 5 out of 91 patients (5.5%), 1 of which was found in the 17 patients with LRs (5.9%). Eleven of 13 LR patients (84.6%) with available treatment plans and radiographic imaging data received postoperative RT; the median total RT dose was 60 Gy. Volumetric-modulated arc therapy was used in 10 (76.9%), intensity-modulated RT in 2 (15.4%), and 3-dimensional conformal radiation therapy in 1 (7.7%) of 13 LRs.
The majority of LRs occurred within the PTV suggesting that LR is most likely not a consequence of inadequate target volume definition, but rather of radioresistant tumor biology. To further improve local tumor control, future research on the potential of dose escalation with normal tissue sparing, STS subtype-specific tumor biology, radiosensitivity, and surgical technique is indicated.
放射治疗（RT）是高级别软组织肉瘤（STS）治疗的主要手段。我们试图研究接受术前或术后放疗的四肢和躯干壁STS患者局部复发（LR）与靶区体积、临床病程及肿瘤特征的关系。
在这项回顾性研究中，分析了2004年至2021年间在我院接受术前或术后放疗的91例原发性诊断为局限性高级别四肢和躯干壁STS成年患者的LR发生率和模式。比较了诊断时和LR时的放射治疗计划和影像数据集。
91例患者中有17例（18.7%）出现LR，中位时间为12.7个月。在复发时有可用治疗计划和影像学数据的13例LR中，10例（76.9%）的LR发生在计划靶区（PTV）内，2例LR为边缘性（15.4%，在PTV体积边缘），1例复发于靶区外（7.7%，在PTV体积外）。91例患者中有5例（5.5%）发现手术切缘阳性（显微镜下或肉眼可见），其中1例出现在17例发生LR的患者中（5.9%）。13例有可用治疗计划和影像学数据的LR患者中有11例（84.6%）接受了术后放疗；总放疗剂量中位数为60 Gy。13例LR中，10例（76.9%）采用容积调强弧形放疗，2例（15.4%）采用调强放疗，1例（7.7%）采用三维适形放疗。
大多数LR发生在PTV内，提示LR很可能不是靶区体积定义不足的结果，而是放射抵抗性肿瘤生物学特性所致。为进一步改善局部肿瘤控制，有必要对正常组织保护下的剂量递增潜力、STS亚型特异性肿瘤生物学特性、放射敏感性和手术技术进行未来研究。
