Sondak V K, Robertson J M, Sussman J J, Saran P A, Chang A E, Lawrence T S
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0932, USA.
Ann Surg Oncol. 1998 Mar;5(2):106-12. doi: 10.1007/BF02303842.
Local control remains an important issue in the management of large soft tissue sarcomas. Radiation is the main adjuvant to surgery for local therapy of sarcomas, but it requires relatively high doses, hitherto considered prohibitive in areas such as the retroperitoneum. We developed a preoperative treatment approach to large soft tissue sarcomas that would deliver a high total dose of radiation administered in conjunction with the halogenated pyrimidine radiosensitizer idoxuridine (IdUrd).
Thirty-seven patients with large sarcomas of the head and neck, mediastinum, retroperitoneum, or extremity received three or five cycles of sequential IdUrd infusion (1000-1600 mg/m2/d x 5 d) alternating weekly with twice daily radiation (125-150 cGy per dose) and were then evaluated for resection. The delivered preoperative radiation dose was up to 6250 to 7500 cGy.
Five patients (14%) had a partial response to preoperative therapy, and 28 of 37 patients underwent successful resection. There were no intra- or postoperative deaths. Local control was achieved in 19 of 28 resected patients, but in only 1 of 6 patients who remained unresectable despite therapy. With a median follow-up of 5.8 years, 28% of patients are alive with no evidence of disease, 17% are alive with disease, and 53% have died of their disease.
Using the dose and schedule we employed, resection of large soft tissue sarcomas was possible after high-dose radiation delivered in conjunction with IdUrd. Although local control was acceptable, the high rate of distant failure represents a limitation of any local approach to the treatment of large soft tissue sarcomas and suggests the need for integration of this approach with an effective systemic therapy.
局部控制仍然是大型软组织肉瘤治疗中的一个重要问题。放射治疗是肉瘤局部治疗中手术的主要辅助手段，但需要相对较高的剂量，在诸如腹膜后等区域，迄今为止这被认为是过高的剂量。我们开发了一种针对大型软组织肉瘤的术前治疗方法，该方法将给予高总剂量的放射治疗，并联合卤化嘧啶放射增敏剂碘苷（IdUrd）。
37例头颈部、纵隔、腹膜后或四肢大型肉瘤患者接受了三个或五个周期的序贯IdUrd输注（1000 - 1600 mg/m²/d×5天），每周交替进行两次每日放射治疗（每剂量125 - 150 cGy），然后评估是否可进行切除。术前给予的放射剂量高达6250至7500 cGy。
5例患者（14%）对术前治疗有部分反应，37例患者中有28例成功进行了切除。术中及术后均无死亡病例。28例切除患者中有19例实现了局部控制，但在6例尽管接受治疗仍无法切除的患者中只有1例实现了局部控制。中位随访5.8年，28%的患者存活且无疾病证据，17%的患者存活但有疾病，53%的患者死于疾病。
采用我们所使用的剂量和方案，在联合IdUrd给予高剂量放射治疗后，大型软组织肉瘤是有可能切除的。尽管局部控制情况尚可，但远处转移失败率较高，这代表了任何大型软组织肉瘤局部治疗方法的局限性，并提示需要将这种方法与有效的全身治疗相结合。
