Razek A, Perez C A, Tefft M, Nesbit M, Vietti T, Burgert E O, Kissane J, Pritchard D J, Gehan E A
Cancer. 1980 Aug 1;46(3):516-21. doi: 10.1002/1097-0142(19800801)46:3<516::aid-cncr2820460316>3.0.co;2-k.
One hundred ninety-three patients with localized Ewing's sarcoma treated at participating instutitions of the Intergroup Ewing's Sarcoma Study form the basis for this report. All patients received radiation therapy to the primary lesion and were randomized to receive vincristine, actinomycin-D, and cyclophosphamide (VAC) plus adriamycin (Regimen I); VAC alone (Regimen II); or VAC and bilateral pulmonary irradiation (Regimen III). Local control was achieved in 96% of the patients in Regimen I, and 86% of the patients in both Regimens II and III. The median duration of follow up was 83 weeks and median survival time was 172 weeks. Incremental doses of irradiation did not result in significant changes in the rate of local control of primary lesions. The local control rate was the same (92%) for tumors treated by means of whole-bone irradiation or with at least 5 cm of free margin around the lesion. The local control rate decreased to 79% for lesions treated with less than 5-cm margin. Excellent control was obtained for lesions involving the skull or spine (100%), and distal bones (fibula, 96% and tibia, 91%). Less favorable control rates were noted for pelvic and humeral lesions (84% and 79%, respectively). Bilateral pulmonary irradiation for subclinical disease played a role in lowering the incidence of lung metastases from 38% to 20% for patients treated with VAC. Lung metastases were similarly decreased (10%) when adriamycin was added to VAC chemotherapy.
本报告基于在尤因肉瘤协作组研究的参与机构接受治疗的193例局限性尤因肉瘤患者。所有患者均接受了原发灶的放射治疗，并被随机分为接受长春新碱、放线菌素D和环磷酰胺（VAC）加阿霉素（方案I）；单纯VAC（方案II）；或VAC及双侧肺部照射（方案III）。方案I中96%的患者实现了局部控制，方案II和方案III中的这一比例均为86%。随访的中位持续时间为83周，中位生存时间为172周。递增剂量的照射并未导致原发灶局部控制率发生显著变化。采用全骨照射或病变周围至少有5 cm切缘治疗的肿瘤，其局部控制率相同（92%）。切缘小于5 cm治疗的病变，局部控制率降至79%。累及颅骨或脊柱的病变（100%）以及远端骨（腓骨，96%；胫骨，91%）获得了良好的控制。骨盆和肱骨病变的控制率则不太理想（分别为84%和79%）。对于亚临床疾病进行双侧肺部照射，可使接受VAC治疗的患者肺转移发生率从38%降至20%。在VAC化疗中加入阿霉素时，肺转移率也有类似下降（10%）。
