Combined modality management of local and disseminated adult soft tissue sarcomas: a review of 257 cases seen over 10 years at the Christie Hospital & Holt Radium Institute, Manchester.
Combined modality management of local and disseminated adult soft tissue sarcomas: a review of 257 cases seen over 10 years at the Christie Hospital & Holt Radium Institute, Manchester.
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局部和播散性成人软组织肉瘤的综合治疗：对克里斯蒂医院 10 年来 257 例病例的回顾
作者：
V. Bramwell;D. Crowther;D. Deakin;R. Swindell;M. Harris
1974 年至 1984 年的 10 年间，曼彻斯特克里斯蒂医院肿瘤内科对 257 例成人组织肉瘤病例进行了评估。登记时，162 例 (63%) 存在局部晚期或转移性疾病。男女比例为 1.5:1，中位年龄 54 岁（范围 14-85）。最常见的部位是下肢（33%）、内脏（21%）、躯干（13%）、腹膜后（12%）和上肢（10%）。平滑肌肉瘤（27%）、脂肪肉瘤（14%）、恶性纤维组织细胞瘤（10%）和神经加纤维肉瘤（15%）是最常见的组织学亚型。高比例的子宫肉瘤（17%）是与许多其他系列的区别点。 72% 的病例明确了组织学分级，其分布（I 级--27%；II--6%；III--67%）反映了对晚期疾病的转诊偏倚。 76%的病例进行了原发肿瘤的局部切除。在许多情况下，这仅相当于“剔除”，真正的区室切除很少见。 31% 的肢体肉瘤患者接受了截肢手术。 98 名患者 (38%) 在转诊前经历过一次或多次局部复发，总体局部复发率为 56%。合适的患者 (78%) 接受了化疗，50% 进入了与 EORTC 合作的多中心试验。晚期疾病患者最常用的治疗方案是 CYVADIC，其总体缓解率为 37%。异环磷酰胺作为单药用于 16 名患者，诱导 3CR 和 5PR，总体缓解率为 50%。当与 MTX 和 VADIC 联合使用时，缓解率没有差异，但这些试点研究的数量很少。 17 名高危患者接受了 VAC 辅助化疗，但结果（11 名复发）令人失望。一项 EORTC 试验将辅助 CYVADIC 化疗与对照化疗进行比较，已招募了 307 名患者，其中 49 名来自克里斯蒂医院。该中心的初步结果 - 对照组中有 13/25 复发，化疗组中有 5/23 - 表明化疗具有优势，但数据在统计学上并不显着。 51 名患者在切除原发肿瘤或局部复发后进行了术后根治性放疗，65% 的病例局部控制，但 41% 的患者出现转移。截至分析时（1984 年 4 月 1 日），98 人（38%）还活着，其中 72 人没有表现出疾病迹象，52 人从未复发。 92%的死亡原因是恶性肿瘤。总生存率不受性别影响，但 40 岁以下的患者表现明显更好（P 小于 0.001）。（摘要截断为 400 字）
Over a 10 year period, between 1974-1984, 257 adult cases of tissue sarcoma have been evaluated in the Department of Medical Oncology, Christie Hospital, Manchester. At registration locally advanced or metastatic diseases was present in 162 (63%). The male/female ratio was 1.5:1 and median age 54 years (range 14-85). The commonest sites were lower limb (33%), visceral (21%), trunk (13%), retroperitoneum (12%) and upper limb (10%). Leiomyosarcoma (27%), liposarcoma (14%) malignant fibrous histiocytoma (10%) and neuro plus fibrosarcomas (15%) were the most frequent histological subtypes. A high proportion of uterine sarcomas (17%) is a point of distinction from many other series. Histological grade was specified in 72% of cases and the distribution (Grade I--27%; II--6%; III--67%) reflected a referral bias towards advanced disease. Local resection of the primary tumour was performed in 76% of cases. In many instances this only amounted to 'shelling out' and true compartmental excisions were rare. Amputation was performed in 31% of patients with limb sarcomas. Ninety-eight patients (38%) had experienced one or more local recurrences prior to referral and the overall local recurrence rate was 56%. Suitable patients (78%) received chemotherapy, 50% entering multicentre trials in collaboration with the EORTC. The commonest regime used in patients with advanced disease was CYVADIC which produced an overall response rate of 37%. Ifosfamide, used as a single agent in 16 patients, induced 3CR and 5PR for an overall response rate of 50%. When used in combination with MTX and VADIC, there was no difference in response rate, but numbers in these pilot studies were small. Seventeen high risk patients received adjuvant chemotherapy with VAC, but the results (11 relapses) were disappointing. An EORTC trial, comparing adjuvant CYVADIC chemotherapy with control has accrued 307 patients, 49 of these from the Christie Hospital. Preliminary results within this centre - 13/25 relapses in the control arm, 5/23 in the chemotherapy arm-suggest an advantage for chemotherapy but the data are statistically not significant. Post-operative radical radiotherapy after resection of the primary tumour or local recurrence was performed in 51 patients, with local control in 65% of cases, although metastases developed in 41%. At the time of analysis (1st April 1984) 98 (38%) were alive, of whom 72 showed no evidence of disease and 52 had never relapsed. Malignant disease was the cause of death in 92%. Overall survival was not influenced by sex, but patients less than 40 years of age fared significantly better (P less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)