The effect of radiation therapy in the treatment of adult soft tissue sarcomas of the extremities: a long‐term community‐based cancer center experience
The effect of radiation therapy in the treatment of adult soft tissue sarcomas of the extremities: a long‐term community‐based cancer center experience
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放射治疗治疗成人四肢软组织肉瘤的效果：基于社区的癌症中心的长期经验
作者：
J. Kneisl;Chad Ferguson;Myra M. Robinson;A. Crimaldi;W. Ahrens;J. Symanowski;Michael Bates;Jennifer L. Ersek;M. Livingston;Joshua C. Patt;Edward S. Kim
本研究的目的是在社区环境中确定保肢手术（LSS）之前或之后外部射束放疗（RT）治疗肢体软组织肉瘤（STS）的效果。将1992年至2010年在我们机构就诊并符合资格标准的患者分层为低（G1）或高（G2，G3）病理分级并进行评价。评估了主要并发症事件，包括截肢、辐射诱导的肉瘤和病理性骨折。采用Kaplan-Meier技术和考克斯比例风险回归模型。162例合格患者接受了LSS治疗肢体STS（120例高度，42例低度）。中位随访时间为5.1年（0.8-20.3年）。对111名患者进行了RT。在未调整的模型中，RT显著降低了高级别STS患者的局部复发（LR）风险（P = 0.005），并有改善无复发生存期（RFS）的趋势（P = 0.069）。在多变量校正模型中，RT显著改善了至LR（P = 0.001）、RFS（P = 0.003）和总生存期（OS）（P = 0.003）的时间。对所有患者的分析显示，接受RT的患者的主要并发症发生率（MCR）为16.2%，而非RT组为3.9%（P = 0.037）;然而，当分析仅限于高级别肉瘤时，MCR的差异无显著性。在我们对接受保肢手术（LSS）的肢体STS患者的大量经验中，RT显著改善了高级别肿瘤患者的局部复发（LR）、RFS和OS。RT的疗效获益应与潜在并发症进行权衡。在切除的高级别肉瘤患者中应考虑外照射RT。
The aim of the study was to determine the effect of external beam radiotherapy (RT) in the treatment of extremity soft tissue sarcoma (STS) before or after limb‐sparing surgery (LSS) in a community‐based setting. Patients presenting to our institution from 1992 to 2010 and meeting eligibility criteria were stratified into low (G1) or high (G2, G3) pathologic grade and evaluated. Major complication events, including amputation, radiation‐induced sarcoma, and pathologic fracture, were assessed. Kaplan–Meier techniques and Cox proportional hazards regression models were used. One hundred and sixty‐two eligible patients underwent LSS for extremity STS (120 high grade, 42 low grade). Median time of follow‐up was 5.1 years (0.8–20.3 years). RT was administered to 111 patients. In unadjusted models, RT significantly decreased the risk of local recurrence (LR) in high‐grade STS patients (P = 0.005) and had a trend for improved recurrence‐free survival (RFS) (P = 0.069). In multivariable‐adjusted models, RT significantly improved time to LR (P = 0.001), RFS (P = 0.003), and overall survival (OS) (P = 0.003). Analysis of all patients showed those who underwent RT had a major complication rate (MCR) of 16.2%, compared to 3.9% in the no RT group (P = 0.037); however, the difference in MCR did not differ significantly when the analysis was restricted to high‐grade sarcomas. In our large experience of patients with extremity STS undergoing limb sparing surgery (LSS), RT significantly improved local recurrence (LR), RFS, and OS, in patients with high‐grade tumors. Efficacy benefits of RT should be weighed against potential complications. External beam RT should be considered in patients with resected high‐grade sarcomas.
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影响因子：
45.3
作者：
Wang, Dian;Zhang, Qiang;Kirsch, David G.
通讯作者：
Kirsch, David G.
影响因子：
45.3
作者：
Pisters, PWT;Leung, DHY;Brennan, MF
通讯作者：
Brennan, MF
影响因子：
3.8
作者：
Nguyen, J.;Moteabbed, M.;Paganetti, H.
通讯作者：
Paganetti, H.
高级软组织肉瘤的放射疗法的生存率提高了：SEER分析。
DOI：
10.1016/j.ijrobp.2009.04.051
发表时间：
2010-05-01
影响因子：
7
作者：
Koshy, Matthew;Rich, Shayna E.;Mohiuddin, Majid M.
通讯作者：
Mohiuddin, Majid M.