Lebas Arthur, Le Fevre Clara, Waissi Waisse, Chambrelant Isabelle, Brinkert David, Noel Georges
Radiotherapy Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France.
Radiotherapy Department, Léon Bérard Center, 28 Rue Laennec, 69008 Lyon, France.
Cancers (Basel). 2024 May 23;16(11):1977. doi: 10.3390/cancers16111977.
Soft tissue sarcomas of the extremities (ESTSs) pose significant challenges in treatment and management due to their diverse nature and potential complications. This study aimed to assess complications associated with multimodal treatments involving surgery and radiotherapy (RT) and to identify potential risk factors.
We retrospectively analyzed nonmetastatic ESTS patients treated with surgery and pre- or post-operative RT between 2007 and 2020 in Strasbourg, France. Complications, including wound complications (WCs), lymphedema, acute and chronic RT-related complications, and fractures, were meticulously evaluated.
A total of 169 patients diagnosed with localized ESTSs were included, with a median age of 64 years (range 21-94 years). ESTSs primarily occurred proximally (74.6%) and in the lower limbs (71%). The median follow-up was 5.5 years. WCs occurred in 22.5% of patients, with proximal and lower extremity tumors being significant risk factors. Acute RT-related complications included radiodermatitis, with grade ≥ 2 occurring in 43.1% of patients, which was associated with superficial tumors. Three patients had an edema grade ≥ 2. Chronic complications included telangiectasias (21.7%) and fibrosis (38.7%), with higher rates associated with larger PTVs and higher RT doses, respectively. Fractures occurred in 5 patients, mainly in the tibia (40%).
Multimodal treatment of ESTSs demonstrated excellent tolerance, with manageable side effects. Numerous risk factors have been highlighted, providing insights for optimizing treatment strategies and enhancing patient care in this rare disease.
四肢软组织肉瘤（ESTSs）因其性质多样和潜在并发症，在治疗和管理方面面临重大挑战。本研究旨在评估与手术和放疗（RT）联合的多模式治疗相关的并发症，并确定潜在风险因素。
我们回顾性分析了2007年至2020年在法国斯特拉斯堡接受手术及术前或术后放疗的非转移性ESTS患者。对并发症进行了细致评估，包括伤口并发症（WCs）、淋巴水肿、急慢性放疗相关并发症及骨折。
共纳入169例诊断为局限性ESTSs的患者，中位年龄64岁（范围21 - 94岁）。ESTSs主要发生在近端（74.6%）和下肢（71%）。中位随访时间为5.5年。22.5%的患者发生WCs，近端和下肢肿瘤是显著危险因素。急性放疗相关并发症包括放射性皮炎，≥2级发生在43.1%的患者中，与浅表肿瘤相关。3例患者水肿≥2级。慢性并发症包括毛细血管扩张（21.7%）和纤维化（38.7%），分别与较大的计划靶体积（PTV）和较高的放疗剂量相关。5例患者发生骨折，主要在胫骨（40%）。
ESTSs的多模式治疗耐受性良好，副作用可控。已突出了众多危险因素，为优化这种罕见疾病的治疗策略和加强患者护理提供了见解。
