LeVay J, O'Sullivan B, Catton C, Bell R, Fornasier V, Cummings B, Hao Y, Warr D, Quirt I
Deprtment of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada.
Int J Radiat Oncol Biol Phys. 1993 Dec 1;27(5):1091-9. doi: 10.1016/0360-3016(93)90529-5.
To evaluate the outcome, patterns of failure and prognostic factors in this rare disease in adult patients treated at a single institution in the modern era.
The records of all patients (389 cases) with soft tissue sarcoma in the extremities, torso (excluding retroperitoneum), and head and neck managed between 1980 and 1988 were reviewed. A curative (radical) approach was used in 321 patients of whom 10% were recurrent lesions. The local management consisted of surgery alone in 54 cases, surgery and radiotherapy in 250 and radiotherapy alone in 17. Adjuvant chemotherapy was used as a policy for high grade lesions in the initial five years of the study (98 cases), but was omitted subsequently.
Extremity lesions fared more favourably compared to head and neck and torso lesions (p = 0.02) with respect to survival. Extremity and torso lesions had significantly better local control (p < 0.0001) than in the head and neck where local failure was a common cause of death. A multiple Cox regression analysis revealed that resection margins, local extension of tumor, age at diagnosis, and grade correlated with local relapse and distant relapse was also associated with local extension, high grade and in addition, large lesions. Size appeared especially predictive for distant failure, the most common cause of death. Distant failure was not influenced by the use of adjuvant chemotherapy. Patients treated for recurrence in this series had significantly worse survival due to increased distant failure despite similar local control to primary cases.
This series highlights the overall problem of distant failure in this disease. It also reaffirms the importance of obtaining local control both in the head and neck, where uncontrolled local disease is the major cause of death, and in general since local relapse appears to increase the risk of distant failure. It appears that the current staging systems should be reviewed in the light of the apparent effect of different prognostic factors.
评估在现代单一机构接受治疗的成年患者中这种罕见疾病的治疗结果、失败模式和预后因素。
回顾了1980年至1988年间收治的所有四肢、躯干（不包括腹膜后）以及头颈部软组织肉瘤患者（389例）的记录。321例患者采用了根治性治疗方法，其中10%为复发病变。局部治疗包括54例单纯手术、250例手术加放疗以及17例单纯放疗。在研究的最初五年，辅助化疗用于高级别病变（98例），但随后被省略。
就生存率而言，四肢病变的预后比头颈部和躯干病变更有利（p = 0.02）。四肢和躯干病变的局部控制明显优于头颈部（p < 0.0001），头颈部局部失败是常见的死亡原因。多因素Cox回归分析显示，手术切缘、肿瘤局部扩展、诊断时年龄和分级与局部复发相关，远处复发也与局部扩展、高级别以及大肿瘤病变相关。肿瘤大小似乎对远处失败具有特别的预测性，远处失败是最常见的死亡原因。远处失败不受辅助化疗使用的影响。本系列中接受复发治疗的患者生存率明显较差，原因是远处失败增加，尽管局部控制与原发性病例相似。
本系列突出了该疾病远处失败的总体问题。它还重申了在头颈部获得局部控制的重要性，在头颈部，局部疾病失控是主要死亡原因，总体而言也是如此，因为局部复发似乎会增加远处失败的风险。鉴于不同预后因素的明显影响，似乎应重新审视当前的分期系统。
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