软组织肉瘤术前放化疗（改良埃尔伯方案）与术前/术后放疗的对比：基于人群的分析
Preoperative Chemoradiation (Modified Eilber Protocol) Versus Preoperative/Postoperative Radiotherapy for Soft Tissue Sarcomas: A Population-Based Analysis.
作者信息
Padmore Greg M, Kurien Elizabeth C, Monument Michael J, Mack Lloyd, Bouchard-Fortier Antoine
机构信息
Division of Surgical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N1N4, Canada.
出版信息
Curr Oncol. 2025 Jun 26;32(7):374. doi: 10.3390/curroncol32070374.
BACKGROUND
Local recurrence for high-risk extremities/trunk soft tissue sarcoma (STS) after treatment can range from 15 to 30%. The modified Eilber protocol (MEP) using low-dose intravenous chemotherapy with a reduced dosage of radiation in the preoperative setting has demonstrated excellent local control and reduced wound complications in these patients. The aim of the current study was to assess long-term local control and overall survival in patients with STS treated with the MEP versus standard preoperative or postoperative radiotherapy.
METHODS
Patients diagnosed with STS from 2004 to 2016 were identified using the Alberta Cancer Registry. Patients with STS treated with the MEP, preoperative or postoperative radiotherapy, were included. Patient and tumor characteristics, treatments and outcomes were abstracted from the registry and primary chart review. Characteristics were compared using one-way ANOVA for continuous variable and chi-square test and Fisher test for the categorical outcomes. Local recurrence-free survival and overall survival were analyzed using Kaplan-Meier Analysis with Log-rank test.
RESULTS
A total of 242 patients with STS were included, among which 100 (41.3%) received the MEP prior to surgery, 91 (37.6%) had preoperative radiation, and 51 (21.1%) had postoperative radiation. After a median follow up of 4.9 years, there were no significant differences in local recurrence or local recurrence-free survival between patients treated with the MEP vs. preoperative or postoperative radiotherapy (10 vs. 6.6% and 7.8%, respectively, -value NS). There were also no significant differences between groups for recurrence-free survival and overall survival.
CONCLUSIONS
This study demonstrates that the use of the MEP has non-inferior oncologic outcomes compared to standard preoperative or postoperative radiation in a population-based analysis despite reducing the overall dosage of radiation administered. The modified Eilber preoperative chemoradiation protocol may be considered as an additional option for patients with STS.
背景
高危肢体/躯干软组织肉瘤（STS）治疗后的局部复发率为15%至30%。改良的艾尔伯方案（MEP）在术前采用低剂量静脉化疗并减少放疗剂量，已证明在这些患者中具有出色的局部控制效果，并减少了伤口并发症。本研究的目的是评估接受MEP治疗的STS患者与标准术前或术后放疗患者的长期局部控制和总生存率。
方法
使用艾伯塔癌症登记处确定2004年至2016年诊断为STS的患者。纳入接受MEP、术前或术后放疗治疗的STS患者。从登记处和原始病历审查中提取患者和肿瘤特征、治疗方法和结果。连续变量采用单因素方差分析，分类结果采用卡方检验和费舍尔检验比较特征。采用Kaplan-Meier分析和对数秩检验分析无局部复发生存率和总生存率。
结果
共纳入242例STS患者，其中100例（41.3%）在手术前接受了MEP，91例（37.6%）接受了术前放疗，51例（21.1%）接受了术后放疗。中位随访4.9年后，接受MEP治疗的患者与术前或术后放疗患者在局部复发或无局部复发生存率方面无显著差异（分别为10%对6.6%和7.8%，P值无统计学意义）。在无复发生存率和总生存率方面，各组之间也无显著差异。
结论
本研究表明，在基于人群的分析中，尽管减少了放疗的总剂量，但与标准术前或术后放疗相比，使用MEP具有非劣效的肿瘤学结果。改良的艾尔伯术前放化疗方案可被视为STS患者的另一种选择。
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