Ballo M T, Zagars G K, Pollack A
Department of Radiation Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):1007-14. doi: 10.1016/s0360-3016(98)00285-5.
To evaluate the outcome of patients with extra-mesenteric desmoid tumors treated with radiation therapy, with or without surgery.
The outcome for 75 patients receiving radiation for desmoid tumor with or without complete gross resection between 1965 and 1994 was retrospectively reviewed utilizing univariate and multivariate statistical methods.
With a median follow-up of 7.5 years, the overall freedom from relapse was 78% and 75% at 5 and 10 years, respectively. Of the total, 23 patients received radiation for gross disease because it was not resectable. Of these 23 patients, 7 sustained local recurrence, yielding a 31% actuarial relapse rate at 5 years. Radiation dose was the only significant determinant of disease control in this group. A dose of 50 Gy was associated with a 60% relapse rate, whereas higher doses yielded a 23% relapse rate (p < 0.05). The other 52 patients received radiation in conjunction with gross total resection of tumor. The 5- and 10-year relapse rates were 18% and 23%, respectively. No factor correlated significantly with disease outcome. There was no evidence that radiation doses exceeding 50 Gy improved outcome. Positive resection margins were not significantly deleterious in this group of irradiated patients. For all 75 patients, there was no evidence that radiation margins exceeding 5 cm beyond the tumor or surgical field improved local-regional control. Ultimately, 72 of the 75 patients were rendered disease-free, but 3 required extensive surgery (amputation, hemipelvectomy) to achieve this status. Significant radiation complications were seen in 13 patients. Radiation dose correlated with the incidence of complications. Doses of 56 Gy or less produced a 5% 15-year complication rate, compared to a 30% incidence with higher doses (p < 0.05).
Radiation is an effective modality for desmoid tumors, either alone or as an adjuvant to resection. For patients with negative resection margins, postoperative radiation is not recommended. Patients with positive margins should almost always receive 50 Gy of postoperative radiation. Unresectable tumors should be irradiated to a dose of approximately 56 Gy, with a 75% expectation of local control.
评估接受放疗（无论是否联合手术）的肠系膜外硬纤维瘤患者的治疗结果。
回顾性分析1965年至1994年间75例接受硬纤维瘤放疗（无论是否行肿瘤全切）患者的治疗结果，采用单因素和多因素统计方法。
中位随访7.5年，5年和10年的总无复发生存率分别为78%和75%。其中，23例患者因肿瘤无法切除而接受针对大体肿瘤的放疗。这23例患者中，7例出现局部复发，5年精算复发率为31%。放疗剂量是该组疾病控制的唯一显著决定因素。50 Gy的剂量与60%的复发率相关，而更高剂量的复发率为23%（p<0.05）。另外52例患者接受放疗联合肿瘤全切。5年和10年复发率分别为18%和23%。没有因素与疾病转归显著相关。没有证据表明超过50 Gy的放疗剂量能改善治疗结果。在这组接受放疗的患者中，切缘阳性并无显著不良影响。对于所有75例患者，没有证据表明超过肿瘤或手术野边缘5 cm的放疗范围能改善局部区域控制。最终，75例患者中有72例达到无病状态，但3例需要接受广泛手术（截肢、半骨盆切除术）才能达到此状态。13例患者出现显著的放疗并发症。放疗剂量与并发症发生率相关。56 Gy及以下剂量的15年并发症发生率为5%，而更高剂量的发生率为30%（p<0.05）。
放疗是治疗硬纤维瘤的有效方式，可单独使用或作为手术辅助治疗。对于切缘阴性的患者，不建议术后放疗。切缘阳性的患者几乎都应接受50 Gy的术后放疗。无法切除的肿瘤应给予约56 Gy的放疗剂量，预期局部控制率为75%。
