Preoperative chemoradiotherapy (modified Eilber protocol) provides maximum local control and minimal morbidity in patients with soft tissue sarcoma
Preoperative chemoradiotherapy (modified Eilber protocol) provides maximum local control and minimal morbidity in patients with soft tissue sarcoma
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DOI：
10.1245/aso.2005.03.064
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发表时间：
2005-08-01
影响因子：
3.7
通讯作者：
Temple, WJ
中科院分区：
文献类型：
--
作者：
Mack, LA;Crowe, PJ;Temple, WJ
背景：软组织肉瘤（STS）治疗后的局部复发率为15% - 30%仍然很常见，但不可接受。我们的假设是，一个完善的新辅助化疗和放疗方案（修改的Eilber方案）提高了局部控制率，同时最小化了主要发病率。方法：1984 ~ 1996年连续治疗深至四肢或躯干筋膜的STS患者，给予阿霉素（30mg /d）治疗3 d，连续放疗（300cgy /d，连续10 d）。在放疗完成后4 - 8周进行大面积切除并保留肢体。前瞻性地记录了治疗并发症、切缘、局部复发和生存率。结果：75例患者中，66%的患者肿瘤面积为0.5 cm， 71%的患者肿瘤为2/3级。在8例患者中，没有达到阴性边缘，其中4例截肢（95%肢体保留）。其余4例中有3例局部复发，5年和7年精算局部控制率分别为50%和25%。相比之下，在67例切缘阴性的患者中，5年和7年的局部控制率分别为97%和94%，总生存率为63%。虽然切缘（P =.001）和分期（P =.035）相关，但多变量Cox回归分析不显著。死亡的危险因素包括肿瘤分期（危险比1.54,P =.001）和肿瘤分级（危险比1.4,P =.02）。3例（4%）患者因组织丢失需要再次手术，8例（10.6%）患者出现轻微伤口并发症。结论：这种改进的Eilber方案似乎可以最大限度地局部控制并减少四肢/躯干STS的主要伤口并发症。
Background: Local recurrence rates of 15% to 30% after treatment of soft tissue sarcoma (STS) are still common but unacceptable. Our hypothesis was that a refined neoadjuvant chemotherapy and radiation protocol (modified Eilber protocol) improves local control rates while minimizing major morbidity.Methods: Consecutive patients with STS deep to the fascia of the extremity or trunk during 1984 to 1996 were treated with 3 days of doxorubicin (30 mg/day) and sequential radiation (300 cGy/day for 10 days). Wide excision with limb preservation was performed 4 to 8 weeks after radiation completion. Treatment complications, margins, local recurrence, and survival were prospectively documented.Results: Of 75 patients, 66% had tumors > 5 cm, and 71% were grade 2/3. In eight patients, negative margins were not achieved, and four of these had amputation (95% limb salvage). Three of the remaining four had local recurrence with a 5- and 7-year actuarial local control rate of 50% and 25%, respectively. In contrast, of the 67 patients with negative margins, a local control rate of 97% at 5 years and 94% at 7 years and an overall survival of 63% were achieved. Although margin (P =.001) and stage (P =.035) were correlated, these were not significant on multivariate Cox regression analysis. Risk factors for death included tumor stage (hazard ratio, 1.54; P =.001) and tumor grade (hazard ratio, 1.4; P =.02). Three patients (4%) required reoperation for tissue loss, and eight patients (10.6%) developed minor wound complications.Conclusions: This modified Eilber protocol seems to maximize local control and minimize major wound complications for extremity/truncal STS.