Primary tumor necrosis predicts distant control in locally advanced soft-tissue sarcomas after preoperative concurrent chemoradiotherapy.
Primary tumor necrosis predicts distant control in locally advanced soft-tissue sarcomas after preoperative concurrent chemoradiotherapy.
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DOI：
10.1016/j.ijrobp.2009.03.015
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发表时间：
2010-03-15
影响因子：
7
通讯作者：
Connell, Philip P.
中科院分区：
文献类型：
--
作者：
MacDermed, Dhara M.;Miller, Luke L.;Peabody, Terrance D.;Simon, Michael A.;Luu, Hue H.;Haydon, Rex C.;Montag, Anthony G.;Undevia, Samir D.;Connell, Philip P.
已经评估了各种新辅助方法治疗局部晚期软组织肉瘤的效果。这项回顾性研究描述了芝加哥大学开发的 Eilber 疗法的独特修改版本。 1995 年至 2008 年间，治疗了 34 例（28 例 III 期和 6 例 IV 期）肢体局部晚期软组织肉瘤患者。所有患者均接受术前治疗，包括异环磷酰胺（2.5 g/m2/天 × 5 天）和同步放疗（28 Gy，每日 3.5 Gy 剂量），夹在各种化疗方案之间。术后，47% 接受了进一步的辅助化疗。大多数肿瘤 (94%) 为 3 级，且均为 T2b，中位大小为 10.3 cm。 29 名患者（85%）进行了广泛切除，其中 5 名需要截肢。在切除的肿瘤标本中，50% 表现出高（≥90%）治疗引起的坏死，11.8% 具有完全病理反应。所有患者的手术切缘均为阴性。所有患者的 5 年生存率为 42.3%，III 期患者的 5 年生存率为 45.2%。对于保肢患者，5年局部控制率为89.0%，17.2%因伤口并发症需要再次手术。 5 年无远处转移 (FFDM) 为 53.4%（排除 IV 期患者），如果治疗引起的肿瘤坏死≥90%，则 FFDM 优越（84.6% vs. 19.9%，p=0.02）。这种耐受性良好的同步放化疗方法可实现良好的肢体保留率和局部控制率。由此产生的治疗引起的坏死率可以预测随后的转移风险，并且该信息可能为指导术后全身治疗提供机会。
Various neoadjuvant approaches have been evaluated for the treatment of locally advanced soft tissue sarcomas. This retrospective study describes a uniquely modified version of the Eilber regimen developed at University of Chicago. Thirty-four patients (28 stage III and 6 stage IV) patients with locally advanced soft tissue sarcomas of an extremity were treated between 1995 and 2008. All patients received preoperative therapy including ifosfamide (2.5 g/m2/day × 5 days) with concurrent radiation (28 Gy in 3.5 Gy daily fractions), sandwiched between various chemotherapy regimens. Postoperatively, 47% received further adjuvant chemotherapy. Most tumors (94%) were grade 3 and all were T2b, with a median size of 10.3 cm. Wide excision was performed in 29 patients (85%), and 5 required amputation. Of the resected tumor specimens, 50% exhibited high (≥90%) treatment-induced necrosis and 11.8% had a complete pathologic response. Surgical margins were negative in all patients. The 5-year survival was 42.3% for all patients and 45.2% for stage III patients. For limb-preservation patients, the 5-year local control was 89.0% and reoperation was required for wound complications in 17.2%. The 5-year freedom from distant metastasis (FFDM) was 53.4% (stage IV patients excluded), and FFDM was superior if treatment-induced tumor necrosis was ≥90% (84.6% vs. 19.9%, p=0.02). This well-tolerated concurrent chemoradiotherapy approach yields excellent rates of limb preservation and local control. The resulting treatment-induced necrosis rates are predictive of subsequent metastatic risk, and this information may provide an opportunity to guide postoperative systemic therapies.
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DOI：
10.1016/0360-3016(95)00111-b
发表时间：
1995-07-15
影响因子：
7
作者：
MUNDT, AJ;AWAN, A;WEICHSELBAUM, RR
通讯作者：
WEICHSELBAUM, RR
影响因子：
3.7
作者：
Mack, LA;Crowe, PJ;Temple, WJ
通讯作者：
Temple, WJ
影响因子：
8.4
作者：
Gortzak, E;Azzarelli, A;Verweij, J
通讯作者：
Verweij, J
影响因子：
45.3
作者：
Kraybill, WG;Harris, J;Eiaberg, B
通讯作者：
Eiaberg, B
影响因子：
3.7
作者：
KAPLAN, EL;MEIER, P
通讯作者：
MEIER, P