External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis
External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis
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DOI：
10.1245/s10434-017-6081-2
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发表时间：
2018-03-01
影响因子：
3.7
通讯作者：
Angele, Martin K.
中科院分区：
文献类型：
--
作者：
Albertsmeier, Markus;Rauch, Alexandra;Angele, Martin K.
本研究的目的是评价手术前后外照射治疗不同部位可切除软组织肉瘤(STSS)的作用。通过系统的文献检索，确定研究EBRT(与非EBRT)对局部复发(LR)和总生存率(OS)的影响的研究，或比较不同的EBRT序列。随机效应荟萃分析被计算并以累积优势比(OR)表示。16项研究(n=3958名患者)比较了EBRT和非EBRT，其中包括一项肢体肉瘤的随机对照试验(RCT)。无论是腹膜后肿瘤(OR0.47，p<；0.0001)还是其他部位(OR0.49，p=0.001)，放疗似乎都能降低LR。在腹膜后STSS中，EBRT可以改善OS(OR0.37，p<；0.0001)，但在其他肿瘤部位没有改善。11项研究(n=2140)，包括一项随机对照试验，比较了术前和术后的放射治疗。在腹膜后肿瘤(OR0.03，p=0.02)和其他肿瘤部位(OR0.67，p=0.01)，术前放疗后发生LR的发生率较低，而四肢肉瘤的创面并发症在术前放疗后较常见(OR2.92，p<；0.0001)。包括在这项荟萃分析中的几项研究具有较高的偏倚风险，并且尚未有针对腹膜后STSS的随机对照试验发表。这项荟萃分析支持在可切除的STSS患者中使用EBRT进行局部肿瘤控制。基于少量的非随机研究，腹膜后STSS的亚组可能对OS有积极影响。
The aim of this study was to evaluate the role of preoperative and postoperative external beam radiation therapy (EBRT) in the treatment of resectable soft tissue sarcomas (STSs) of different tumor locations.A systematic literature search was performed to identify studies investigating the effects of EBRT (versus no EBRT) on local recurrence (LR) and overall survival (OS) or comparing different EBRT sequences. Random effects meta-analyses were calculated and presented as cumulative odds ratios (ORs).Sixteen studies (n = 3958 patients) comparing EBRT versus no EBRT, including one randomized controlled trial (RCT) in extremity sarcoma, were analyzed. EBRT appeared to reduce LR in both retroperitoneal tumors (OR 0.47, p < 0.0001) and other locations (OR 0.49, p = 0.001). OS was improved by EBRT in retroperitoneal STSs (OR 0.37, p < 0.0001) but not in other tumor locations. Eleven studies (n = 2140), including one RCT, compared preoperative and postoperative radiotherapy. LR was less frequent following preoperative EBRT in retroperitoneal STSs (OR 0.03, p = 0.02), as well as in other tumor locations (OR 0.67, p = 0.01), while wound complications in extremity sarcoma were more frequent following preoperative EBRT (OR 2.92, p < 0.0001). Several studies included in this meta-analysis bear a high risk of bias and no RCT has been published for retroperitoneal STS.This meta-analysis supports the use of EBRT for local tumor control in patients with resectable STSs. Based on a small number of non-randomized studies, a positive effect on OS may exist in the subgroup of retroperitoneal STSs.