Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Department of Orthopedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka-shi, Osaka, 530-0012, Japan.
Int J Clin Oncol. 2024 Jul;29(7):1044-1051. doi: 10.1007/s10147-024-02534-y. Epub 2024 Apr 24.
Because myxoid liposarcomas are more radiosensitive than other soft tissue sarcomas, there have been several reports of 50 Gy preoperative radiation therapy combined with surgery, but the wound complication rate is reportedly high. We have performed preoperative irradiation at a reduced dose of 40 Gy and definitive radiation therapy for unresectable cases. This study aimed to report the tumor reduction rate and oncological results with a reduced dose of preoperative irradiation and the outcome of definitive irradiation for unresectable cases.
Forty-one patients with myxoid liposarcoma treated in our institution between 2002 and 2021 were included. We examined the tumor volume shrinkage rate with preoperative radiation, compared complications and oncological outcomes between preoperative radiation and surgery-only cases, and investigated the prognosis and tumor shrinkage of definitive radiation cases.
The total dose irradiated was 40 Gy except in two cases. The mean tumor volume reduction rate was 52.0%. A decreased dose of preoperative radiation did not worsen clinical outcomes with fewer complications. The total dose of definitive radiation was approximately 60 Gy. The mean tumor volume reduction rate was 55.0%. The tumor shrinkage maintenance rate was 100% in a median follow-up period of 50.5 months.
Preoperative radiation therapy for myxoid liposarcoma near vital organs is a good approach because even with a reduced dose of 40 Gy, significant tumor reduction and excellent results were achieved. Definitive radiation therapy is the recommended treatment for older patients with serious comorbidities or inoperable patients.
由于黏液样脂肪肉瘤比其他软组织肉瘤更具放射敏感性，因此有报道称，50Gy 的术前放疗联合手术可取得良好的疗效，但据报道其伤口并发症发生率较高。我们采用 40Gy 的低剂量行术前放疗，并对无法切除的病例进行根治性放疗。本研究旨在报告采用低剂量术前放疗的肿瘤退缩率和肿瘤学结果，以及无法切除病例的根治性放疗结果。
本研究纳入了 2002 年至 2021 年期间在我院治疗的 41 例黏液样脂肪肉瘤患者。我们检查了术前放疗的肿瘤体积退缩率，比较了术前放疗和单纯手术病例的并发症和肿瘤学结果，并研究了无法切除病例的根治性放疗的预后和肿瘤退缩情况。
除了 2 例患者外，总照射剂量均为 40Gy。平均肿瘤体积退缩率为 52.0%。降低术前放疗剂量并未导致并发症恶化，临床结局反而有所改善。根治性放疗的总剂量约为 60Gy。平均肿瘤体积退缩率为 55.0%。在中位随访 50.5 个月时，肿瘤退缩维持率为 100%。
对于靠近重要器官的黏液样脂肪肉瘤，术前放疗是一种很好的治疗方法，因为即使采用 40Gy 的低剂量，也能获得显著的肿瘤退缩和良好的疗效。对于年龄较大、合并严重合并症或无法手术的患者，根治性放疗是推荐的治疗方法。
