Chaudhary A J, Laskar S, Badhwar R
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
Strahlenther Onkol. 1998 Oct;174(10):522-8. doi: 10.1007/BF03038985.
Soft tissue sarcomas are relatively rare tumors with an aggressive natural history associated with a high propensity for local recurrence following conservative surgery. It accounts for 1.8% of all cancers seen at the Tata Memorial Hospital, Mumbai. Organ preserving surgery and tumor bed brachytherapy have revolutionized the management of soft tissue sarcomas.
One hundred and seventy-seven patients with histologically proven non-metastatic cases of soft tissue sarcomas in the age group of 16 to 79 years (median 41 years) were treated at the Tata Memorial Hospital between January 1983 and December 1992. One hundred and fifty-one patients who had completed a minimum of 24 months of treatment were studied. There were 100 males (66%) and 51 females (33%). The majority had recurrent lesions (70.3%). Extremities were involved in 75% of patients. Spindle cell sarcoma was the major histologic variant (30%). The patients underwent function preserving surgery and temporary afterloading Ir-192 tumor bed brachytherapy with or without external radiotherapy.
In patients receiving brachytherapy only, 25 out of 33 (75%) were locally controlled after a median follow-up of 30 months. After successful salvage of local failures the overall local control improved to 82%. Similarly in the patients who received both interstitial brachytherapy and external irradiation, the local control rate after a median follow-up of 40 months was 71% which improved to 86% after successful salvage. The overall treatment related complication rate was less than 1%. The only marginally significant prognostic factor for local control was tumor grade (p = 0.06).
The sequential combination of limited surgery and tumor bed brachytherapy with or without external radiotherapy has been established as an effective alternative to more ablative procedures like amputation. Histologic grade has proven to be a significant factor determining local control.
软组织肉瘤是相对罕见的肿瘤，其自然病程具有侵袭性，保守手术后局部复发倾向较高。它占孟买塔塔纪念医院所见所有癌症的1.8%。保器官手术和瘤床近距离放疗彻底改变了软组织肉瘤的治疗方式。
1983年1月至1992年12月期间，177例年龄在16至79岁（中位年龄41岁）、经组织学证实为非转移性软组织肉瘤的患者在塔塔纪念医院接受治疗。对至少完成24个月治疗的151例患者进行了研究。其中男性100例（66%），女性51例（33%）。大多数患者有复发病变（70.3%）。75%的患者病变累及四肢。梭形细胞肉瘤是主要的组织学亚型（30%）。患者接受了保功能手术，并接受了临时后装铱-192瘤床近距离放疗，部分患者联合或不联合外照射放疗。
仅接受近距离放疗的患者中，33例中有25例（75%）在中位随访30个月后实现局部控制。在成功挽救局部复发后，总体局部控制率提高到82%。同样，接受间质近距离放疗和外照射放疗的患者，中位随访40个月后的局部控制率为71%，成功挽救后提高到86%。总体治疗相关并发症发生率低于1%。唯一对局部控制有轻微显著影响的预后因素是肿瘤分级（p = 0.06）。
有限手术与瘤床近距离放疗联合或不联合外照射放疗的序贯组合已被确立为截肢等更广泛切除手术的有效替代方案。组织学分级已被证明是决定局部控制的重要因素。
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