Radiotherapy for local control of osteosarcoma
Radiotherapy for local control of osteosarcoma
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DOI：
10.1016/j.ijrobp.2004.05.051
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发表时间：
2005-02-01
影响因子：
7
通讯作者：
Suit, HD
中科院分区：
文献类型：
--
作者：
DeLaney, TF;Park, L;Suit, HD
目的：局部控制骨肉瘤的患者切除与满意的边界不能达到可能是困难的。本研究评估了放疗（RT）在这种情况下的疗效。方法和材料：我们在我们的肉瘤数据库中确定了41例骨肉瘤患者，这些患者要么没有切除，要么切除了近缘或阳性切缘，并在1980年至2002年期间在我们的机构接受了外束光子和/或质子放射治疗。回顾患者图表以评估局部控制、无进展生存期、无转移生存期和总生存期。结果：治疗部位为头、脸、颅骨17例，四肢8例，脊柱8例，骨盆7例，躯干1例。41例患者中，27例（65.85%）行肿瘤全切除，9例（21.95%）行次全切除，5例（12.2%）行活检。辐射剂量范围为10 ~ 80 Gy（中位数66）。23例患者（56.1%）接受了部分质子放射治疗。化疗35例（85.4%）。在41例患者中，27例（65.85%）因原发性疾病而接受治疗，10例（24.4%）因局部复发而接受治疗，4例（9.8%）因转移性疾病接受治疗。当地5年总体控制率为68%±8.3%。按切除范围划分的局部控制率，大体全切除78.4% +/- 8.6%，次全切除77.8% +/- 13.9%，活检40% +/- 21.9% （p < 0.01）。根据切除程度，总生存率为：总切除74.45% +/- 9.1%，次全切除74.1% +/- 16.1%，活检25% +/- 21.65% （p < 0.001）。与仅行活检的患者相比，全切除或次全切除的患者有更高的局部控制率、生存率和无病生存率（分别为77.7% +/- 7.5%比40% +/- 21% [p < 0.001]、73.9% +/- 8.1%比25% +/- 21.6% [p < 0.001]、51.9% +/- 9.1%比25% +/- 21.6% [p < 0.01]）。首发治疗的患者总生存率更高（78.8% +/- 8.6%，复发患者为54% +/- 17.3%），p < 0.05。32例接受大于或等于55 Gy剂量的患者局部控制率为71% +/- 9%，9例接受5.3 cm剂量的患者局部控制率为53.6% +/- 20.1%，9例接受大于或等于55 Gy剂量的患者局部控制率为80% +/- 17.9%，6例接受剂量，但未见肿瘤局部控制的明确剂量-反应关系
Purpose: Local control of osteosarcoma in patients for whom a resection with satisfactory margins is not achieved can be difficult. This study evaluated the efficacy of radiotherapy (RT) in this setting.Methods and Materials: We identified 41 patients in our sarcoma database with osteosarcomas that either were not resected or were excised with close or positive margins and who underwent RT with external beam photons and/or protons at our institution between 1980 and 2002. Patient charts were reviewed to assess local control, progression-free survival, metastasis-free survival, and overall survival.Results: The anatomic sites treated were head/face/skull in 17, extremity in 8, spine in 8, pelvis in 7, and trunk in 1. Of the 41 patients, 27 (65.85%) had undergone gross total tumor resection, 9 (21.95%) subtotal resection, and 5 (12.2%) biopsy only. The radiation dose ranged from 10 to 80 Gy (median 66). Twenty-three patients (56.1%) received a portion of their RT with protons. Chemotherapy was given to 35 patients (85.4%). Of the 41 patients, 27 (65.85%) were treated for localized disease at primary presentation, 10 (24.4%) for local recurrence, and 4 (9.8%) for metastatic disease. The overall local control rate at 5 years was 68% +/- 8.3%. The local control rate according to the extent of resection was 78.4% +/- 8.6% for gross total resection 77.8% +/- 13.9% for subtotal resection, and 40% +/- 21.9% for biopsy only (p < 0.01). The overall survival rate according to the extent of resection was 74.45% +/- 9.1% for gross total resection, 74.1% +/- 16.1% for subtotal resection, and 25% +/- 21.65% for biopsy only (p < 0.001). Patients with either gross or subtotal resection had a greater rate of local control, survival, and disease-free survival compared with those who underwent biopsy only at 5 years (77.7% +/- 7.5% vs. 40% +/- 21% [p < 0.001], 73.9% +/- 8.1% vs. 25% +/- 21.6% [p < 0.001], and 51.9% +/- 9.1% vs. 25% +/- 21.6% [p < 0.01], respectively). Overall survival was better in patients treated at primary presentation (78.8% +/- 8.6% compared with 54% +/- 17.3% for recurrence) p < 0.05). No definitive dose-response relationship for local control of tumor was seen, although the local control rate was 71% +/- 9% for 32 patients receiving doses greater than or equal to55 Gy vs. 53.6% +/- 20.1% for 9 patients receiving 5.3 cm, 9 received doses greater than or equal to55 Gy and the local control rate was 80% +/- 17.9%, and 6 received doses