Roohani Siyer, Griffin Anthony M, Liu Zhihui Amy, Catton Charles N, Dickie Colleen I, Ferguson Peter C, Kirsch David G, O'Sullivan Brian, Shultz David B, Tsoi Kim M, Wong Philip, Wunder Jay S, Chung Peter W M
Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Cancer. 2025 Sep 15;131(18):e70049. doi: 10.1002/cncr.70049.
The objective of this study was to evaluate whether dosimetric sparing of uninvolved normal tissues, including skin/subcutaneous flaps, affects acute and late toxicities in preoperative image-guided intensity-modulated radiation therapy (IG-IMRT) for lower extremity soft tissue sarcomas (LE-STS).
Patients with LE-STS from a phase 2 preoperative IG-IMRT trial (flap-sparing-IMRT, 2005-2009) and a prospectively maintained institutional database (standard-IMRT, 2005-2020) were propensity matched by age, sex, tumor size, grade, location, wound closure, and interval from IG-IMRT to surgery; all received 50 Gy in 25 fractions preoperatively. The primary outcome was major wound complication (MWC). Secondary outcomes were late Radiation Therapy Oncology Group toxicities, functional scores (Toronto Extremity Salvage Score [TESS]; Musculoskeletal Tumor Society scales [MSTS-87 or MSTS-93]), and oncologic outcomes. Kaplan-Meier estimates, cumulative incidence functions, and linear, logistic, and Cox regression were used, as appropriate.
Fifty-five patients who received flap-sparing-IMRT were 1:5 matched to 275 patients who received standard-IMRT (median follow-up, 104 vs. 56 months, respectively). Regression analyses identified no significant association between treatment technique and MWCs (29% vs. 27%; odds ratio, 0.92; p = .77), late grade 2 or greater toxicities: subcutaneous fibrosis (15% vs. 8%), joint stiffness (5% vs. 2%), edema (11% vs. 10%), fracture (2% vs. 4%), or functional outcomes (TESS, 87 vs. 89; MSTS-87, 33 vs. 33; and MSTS-93, 93 vs. 97; all p > .1). Five-year overall survival (83.6% vs. 75.2%), disease-free survival (65.5% vs. 64.1%), local recurrence (5.2% vs. 7.3%), distant metastasis (29.1% vs. 30.1%) were also comparable (p > .1).
Flap-sparing-IMRT with specific avoidance of uninvolved skin/subcutaneous tissues demonstrated minimal differences in MWCs, late toxicity, and functional and oncologic outcomes compared with standard-IMRT in patients with LE-STS.
本研究的目的是评估在术前影像引导调强放射治疗（IG-IMRT）中，对包括皮肤/皮下皮瓣在内的未受累正常组织进行剂量学保护，是否会影响下肢软组织肉瘤（LE-STS）的急性和晚期毒性反应。
来自一项2期术前IG-IMRT试验（皮瓣保留IMRT，2005 - 2009年）和一个前瞻性维护的机构数据库（标准IMRT，2005 - 2020年）的LE-STS患者，根据年龄、性别、肿瘤大小、分级、位置、伤口闭合情况以及从IG-IMRT到手术的时间间隔进行倾向评分匹配；所有患者术前均接受25次分割、总量50 Gy的放疗。主要结局是严重伤口并发症（MWC）。次要结局包括晚期放射治疗肿瘤学组毒性反应、功能评分（多伦多肢体挽救评分[TESS]；肌肉骨骼肿瘤学会量表[MSTS-87或MSTS-93]）以及肿瘤学结局。酌情使用Kaplan-Meier估计法、累积发病率函数以及线性、逻辑和Cox回归分析。
接受皮瓣保留IMRT的55例患者与接受标准IMRT的275例患者按1:5进行匹配（中位随访时间分别为104个月和56个月）。回归分析发现治疗技术与MWC之间无显著关联（29%对27%；优势比，0.92；p = 0.77），晚期2级及以上毒性反应：皮下纤维化（15%对8%）、关节僵硬（5%对2%）、水肿（11%对10%）、骨折（2%对4%）或功能结局（TESS，87对89；MSTS-8
