Keus R B, Rutgers E J, Ho G H, Gortzak E, Albus-Lutter C E, Hart A A
The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam.
Eur J Cancer. 1994;30A(10):1459-63. doi: 10.1016/0959-8049(94)00302-l.
The purpose of this study is to assess the long-term success rate and functional results of limb-sparing therapy in a group of 156 patients with soft tissue sarcomas of the extremities in the Netherlands Cancer Institute, treated according to a standard protocol of surgery and radiotherapy, if indicated. The patients (79 females and 77 males) were treated between 1977 and 1983 by an intended wide local excision with a margin of at least 2 cm. Postoperative radiotherapy was applied in 117 patients; 26 patients had surgery only, including 13 patients who had to be treated by amputation. The total dose was 60 Gy, with 40 Gy to a large volume and a boost of 20 Gy to the tumour bed at 2 Gy per fraction, five fractions per week. Most sarcomas were located in the proximal part of the lower extremity (51%). The group comprised 50 liposarcomas, 47 malignant fibrous hystiocystoma (MFH) and 59 other histologies; 69 (44%) had high-grade tumours. Three treatment groups with limb-sparing treatment were defined: group I (n = 26) patients who had a complete excision receiving no further treatment, group II (n = 64) with narrow surgical margins and radiotherapy and group III (n = 53) with incomplete resection and radiotherapy. The 10-year actuarial overall survival and local control rate for all patients was 63 and 81%, respectively. Multivariate analysis showed that histological grade (P < 0.0001), age (P = 0.0005) and location deep to the fascia (P = 0.0008) were independent prognostic factors for survival, while local control was predicted by grade (P = 0.0014) and treatment group (p = 0.028). Patients with surgery only (group I) had 81% 5-year local control as compared to 92% with radiotherapy after narrow surgery (group II) and 74% with incomplete surgery and radiotherapy (group III). Limb preservation when attempted was achieved in 90% of the patients. After limb-sparing treatment, 7% had severe impairment of mobility, 3% had lymph oedema and 16% marked fibrosis. Fractures in the irradiated bone occurred in 6% of the patients. The combination of limited surgery followed by radiotherapy resulted in a high local control rate with good functional results. Ultimately limb sparing treatment was successful in 83% of all patients with extremity sarcomas.
本研究的目的是评估在荷兰癌症研究所，按照标准手术和放疗方案（如有指征）治疗的156例四肢软组织肉瘤患者保肢治疗的长期成功率和功能结果。这些患者（79名女性和77名男性）在1977年至1983年间接受了至少2厘米切缘的广泛局部切除。117例患者接受了术后放疗；26例患者仅接受了手术，其中包括13例不得不接受截肢治疗的患者。总剂量为60 Gy，40 Gy照射大体积区域，瘤床追加20 Gy，每次2 Gy，每周5次。大多数肉瘤位于下肢近端（51%）。该组包括50例脂肪肉瘤、47例恶性纤维组织细胞瘤（MFH）和59例其他组织学类型；69例（44%）为高级别肿瘤。定义了三个保肢治疗组：I组（n = 26）为完全切除且未接受进一步治疗的患者，II组（n = 64）为手术切缘窄且接受放疗的患者，III组（n = 53）为切除不完全且接受放疗的患者。所有患者的10年精算总生存率和局部控制率分别为63%和81%。多因素分析显示，组织学分级（P < 0.0001）、年龄（P = 0.0005）和筋膜深层位置（P = 0.0008）是生存的独立预后因素，而局部控制由分级（P = 0.0014）和治疗组（P = 0.028）预测。仅接受手术的患者（I组）5年局部控制率为81%，而手术切缘窄后接受放疗的患者（II组）为92%，切除不完全且接受放疗的患者（III组）为74%。90%的患者在尝试保肢时成功保肢。保肢治疗后，7%的患者有严重活动障碍，3%的患者有淋巴水肿，16%的患者有明显纤维化。6%的患者发生了放疗部位的骨折。有限手术加放疗的联合治疗导致了较高的局部控制率和良好的功能结果。最终，83%的四肢肉瘤患者保肢治疗成功。
