Sadoski C, Suit H D, Rosenberg A, Mankin H, Efird J
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
J Surg Oncol. 1993 Apr;52(4):223-30. doi: 10.1002/jso.2930520405.
The relationship between status of the surgical margin and local control of soft tissue sarcoma of the extremities by preoperative radiation therapy has been assessed in 132 consecutive patients from 1974 to 1988. The 5-year actuarial local control rate was 94% for all patients; the rates were 97% and 82% for the 104 tumors with negative margins and the 28 tumors with positive margins, respectively. The local control rate was independent of the extent of the negative margin. For primary sarcomas, the local control rates were 96%, 97%, and 100%, respectively, for margins that were negative at < or = 1 mm or > 1 mm, or the specimens were negative for tumor; for positive margins the result was 83%. The overall local control rate was lower (not significant) for recurrent than for primary sarcomas: 88% vs. 94%. On the other hand, when stratifying by margin status, no difference was observed in local control results, i.e.: (1) 97% and 91% for primary and recurrent tumors with negative margins, respectively, and (2) 83% and 80% for primary and recurrent tumors with positive margins, respectively. Local control was not significantly higher in those patients who were treated by surgical resection (S), radiation (RT), and re-excision of the previous tumor bed than in those whose radiation therapy was started after the biopsy and followed by one surgical resection. For primary sarcomas that were resected with negative margins the results were: 100% of 15 patients treated by S-RT-S and 96% of 75 patients treated by RT-S.
1974年至1988年期间，对132例连续的患者评估了术前放疗后手术切缘状态与肢体软组织肉瘤局部控制之间的关系。所有患者的5年精算局部控制率为94%；切缘阴性的104例肿瘤和切缘阳性的28例肿瘤的局部控制率分别为97%和82%。局部控制率与阴性切缘的范围无关。对于原发性肉瘤，切缘≤1mm或＞1mm为阴性或标本无肿瘤的局部控制率分别为96%、97%和100%；切缘阳性的局部控制率为83%。复发性肉瘤的总体局部控制率低于原发性肉瘤（无统计学意义）：88%对94%。另一方面，按切缘状态分层时，局部控制结果无差异，即：（1）切缘阴性的原发性和复发性肿瘤的局部控制率分别为97%和91%，（2）切缘阳性的原发性和复发性肿瘤的局部控制率分别为83%和80%。接受手术切除（S）、放疗（RT）和先前肿瘤床再次切除治疗的患者，其局部控制率并不显著高于活检后开始放疗并随后进行一次手术切除的患者。对于切缘阴性切除的原发性肉瘤，结果如下：接受S-RT-S治疗的15例患者中有100%，接受RT-S治疗的75例患者中有96%。
