局限性肢体软组织肉瘤中传统分割与超分割术前放疗的病理肿瘤坏死比较及其与临床结局的相关性

Comparison of Pathologic Tumor Necrosis of Conventional Versus Ultrahypofractionated Preoperative Radiation Therapy in Localized Extremity Soft Tissue Sarcoma and Its Correlation With Clinical Outcomes.

作者信息

Hanafi Hanis, Freeman Carolyn R, Tsui James, Ramia Paul, Turcotte Robert, Aoude Ahmed, Bozzo Anthony, Cury Fabio L

机构信息

Department of Oncology, Division of Radiation Oncology, McGill University Hospital Centre, Montreal, Quebec, Canada.

Department of Orthopaedics, McGill University Hospital Centre, Montreal, Quebec, Canada.

出版信息

Pract Radiat Oncol. 2025 Mar-Apr;15(2):e189-e197. doi: 10.1016/j.prro.2024.10.008. Epub 2024 Oct 30.

DOI:10.1016/j.prro.2024.10.008

PMID:39481680

Abstract

PURPOSE

We aimed to determine if ultrahypofractionated radiation therapy (UHYPO-RT) delivering 6 Gy x 5 fractions yields similar tumor necrosis compared with conventional radiation therapy (CONV-RT) with 2 Gy x 25 fractions in soft tissue sarcoma. The clinical significance of tumor necrosis on loco-regional recurrence-free survival (LRFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed.

METHODS AND MATERIALS

Patients with localized soft tissue sarcoma treated with CONV-RT or UHYPO-RT followed by surgery were included. Good response was defined as tumor necrosis ≥90%, and poor response as <90%. The Mann-Whitney U test compared median tumor necrosis. χ analysis was used for categorical variables. The Kaplan-Meier function estimated LRFS, DDFS, and OS.

RESULTS

A total of 64 patients received CONV-RT, and 45 received UHYPO-RT. The median tumor size was 7.0 cm, with the lower extremity being the most common site (55%). Myxofibrosarcoma (39%) and undifferentiated pleomorphic sarcoma (16%) were the most frequent histologies. The median time from radiation therapy to surgery was 35 days. There was a significant difference in median tumor necrosis between CONV-RT and UHYPO-RT, with rates of 40% and 60%, respectively (P = .022). Patients receiving UHYPO-RT had a higher percentage of tumor necrosis at the 90% cutoff, achieving 27% compared with 6% for CONV-RT (P = .003). At a median follow-up of 32 months, 12 patients (9%) experienced loco-regional recurrence, 24 patients (19%) faced distant failure, and 19 patients (15%) died of metastatic disease. Patients with <90% necrosis had higher rates of loco-regional (13% vs 0%, P = .207) and distant failure (25% vs 0%, P = .021). Three-year LRFS was 86% for <90% necrosis and 100% for ≥90% necrosis (P = .160). DDFS was 75% for <90% necrosis versus 100% for ≥90% (P = .036). OS rates were 79% and 93%, respectively (P = .290).

CONCLUSIONS

Preoperative RT with UHYPO-RT was associated with a higher rate of tumor necrosis ≥90% than CONV-RT. Our data suggest that more extensive necrosis is associated with better clinical outcomes.

摘要

目的

我们旨在确定在软组织肉瘤中，给予6 Gy×5次分割的超分割放疗（UHYPO-RT）与给予2 Gy×25次分割的传统放疗（CONV-RT）相比，是否能产生相似的肿瘤坏死情况。评估肿瘤坏死对局部区域无复发生存率（LRFS）、远处无病生存率（DDFS）和总生存率（OS）的临床意义。

方法和材料

纳入接受CONV-RT或UHYPO-RT治疗后行手术的局限性软组织肉瘤患者。良好反应定义为肿瘤坏死≥90%，不良反应定义为<90%。采用曼-惠特尼U检验比较肿瘤坏死中位数。χ分析用于分类变量。采用Kaplan-Meier函数估计LRFS、DDFS和OS。

结果

共有64例患者接受CONV-RT，45例接受UHYPO-RT。肿瘤中位大小为7.0 cm，最常见部位为下肢（55%）。黏液纤维肉瘤（39%）和未分化多形性肉瘤（16%）是最常见的组织学类型。从放疗到手术的中位时间为35天。CONV-RT和UHYPO-RT的肿瘤坏死中位数存在显著差异，分别为40%和60%（P = 0.022）。接受UHYPO-RT的患者在肿瘤坏死率≥90%时的比例更高，达到27%，而CONV-RT为6%（P = 0.003）。中位随访32个月时，12例患者（9%）出现局部区域复发，24例患者（19%）出现远处转移，19例患者（15%）死于转移性疾病。坏死<90%的患者局部区域复发率（13% vs 0%，P = 0.207）和远处转移率（25% vs 0%，P = 0.021）更高。坏死<90%的患者三年LRFS为86%，坏死≥90%的患者为100%（P = 0.160）。DDFS在坏死<90%的患者中为75%，在坏死≥90%的患者中为100%（P = 0.036）。OS率分别为79%和93%（P = 0.290）。