Le Vay J, O'Sullivan B, Catton C, Cummings B, Fornasier V, Gullane P, Simm J
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario.
Arch Otolaryngol Head Neck Surg. 1994 Sep;120(9):981-6. doi: 10.1001/archotol.1994.01880330061011.
This study evaluates the outcome, patterns of failure, and prognostic factors in head and neck soft-tissue sarcoma in the adult.
A retrospective evaluation of 73 patients treated recently for this rare disease. The minimum follow-up for all patients was 3 years with the living patients having a mean follow-up of 4.6 years.
All patients were treated between January 1980 and December 1988, at the Princess Margaret Hospital-Ontario Cancer Institute, Toronto, the major sarcoma referral center for a population in excess of 3 million. PATIENTS OR PARTICIPANTS AND INTERVENTIONS: Fifty-two patients were treated with curative intent: 10 by surgery without radiotherapy and 42 with surgery and radiotherapy. Twelve patients received adjuvant chemotherapy.
Five-year cause-specific survival, local relapse, and distant failure rates were calculated by the product limit method. Comparisons between survival curves were carried out by the log-rank statistic and Cox regression analysis was performed to assess the influence of prognostic factors.
The 5-year cause-specific survival was 62%, with a local relapse rate of 41% and distant relapse rate of 31%. Extension to adjacent structures, high grade, and large lesion size were associated with poorer survival. Gross residual tumor also was associated with high local failure (75% failure) despite the addition of radiation therapy. Those with clear surgical margins or only microscopic involvement fared much more favorably and had similar local control rates (26% and 30% failure, respectively) provided adjuvant radiotherapy was given. However, 68% of patients dying as a result of their sarcoma had uncontrolled local disease because of the high incidence (27%) of gross residuum following surgery in this series.
This series highlights the absolute necessity for resection of all overt disease with planned adjunctive radiotherapy and appropriate reconstruction in most cases. This is achieved more easily in the setting of a specialized sarcoma treatment unit.
本研究评估成人头颈部软组织肉瘤的治疗结果、失败模式及预后因素。
对73例近期接受这种罕见疾病治疗的患者进行回顾性评估。所有患者的最短随访时间为3年，在世患者的平均随访时间为4.6年。
所有患者于1980年1月至1988年12月在安大略省多伦多市玛格丽特公主医院 - 安大略癌症研究所接受治疗，该研究所是一个服务人口超过300万的主要肉瘤转诊中心。患者或参与者及干预措施：52例患者接受了根治性治疗：10例仅接受手术未进行放疗，42例接受手术及放疗。12例患者接受了辅助化疗。
采用乘积限界法计算5年特定病因生存率、局部复发率和远处失败率。通过对数秩检验对生存曲线进行比较，并进行Cox回归分析以评估预后因素的影响。
5年特定病因生存率为62%，局部复发率为41%，远处复发率为31%。侵犯相邻结构、高级别及肿瘤体积大与较差的生存率相关。尽管进行了放射治疗，但大体肿瘤残留也与高局部失败率（75%失败）相关。手术切缘阴性或仅镜下受累的患者情况要好得多，若给予辅助放疗，其局部控制率相似（分别为26%和30%失败）。然而，由于本系列手术中大体残留的发生率较高（27%），68%因肉瘤死亡的患者存在未控制的局部疾病。
本系列研究强调了在大多数情况下，通过计划性辅助放疗和适当重建切除所有明显病变的绝对必要性。在专门的肉瘤治疗单位更容易实现这一点。
