Long-term results with resection of radiation-induced soft tissue sarcomas
Long-term results with resection of radiation-induced soft tissue sarcomas
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DOI：
10.1097/01.sla.0000128686.51815.8b
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发表时间：
2004-06-01
影响因子：
9
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Cha, C;Antonescu, CR;Brennan, MF
前言：放射治疗越来越多地被用作许多儿童和成人恶性肿瘤的辅助治疗。放射诱导的肉瘤是一种公认的罕见事件。方法：1982年7月至2001年12月，我所收治4884例成人肉瘤患者，并记录在前瞻性数据库中。123例(2.5%)患者出现放射性软组织肉瘤。生存率由Kaplan-Meier分析决定。患者、肿瘤和治疗特征的预后意义通过LOG等级和COX比例风险模型进行检验。结果：从放疗到肉瘤发展的中位间隔时间为103(6~534)个月。在114例接受根治性切除的放射诱导肉瘤患者中，5年精算生存率为41%，中位生存期为48个月，中位生存期为36个月。使用放射治疗最常见的恶性肿瘤是乳腺癌(29%)，其次是淋巴瘤(16%)和前列腺癌(15%)。恶性纤维组织细胞瘤(23%)是最常见的组织学诊断，其次是纤维肉瘤(15%)和血管肉瘤(15%)。在单因素和多因素分析中，高级别肿瘤(n=85；79%)、年龄和>60岁(n=61；50%)、大体切缘阳性(n=36；32%)是肉瘤特异性生存不良的预测因素。结论：辅助放射治疗的应用日益增多，尤其是早期乳腺癌，需要长期随访以发现放射诱导肉瘤。手术切除仍是主要治疗方法，但5年存活率仍接近40%。
Introduction: Radiation therapy is increasingly used as adjuvant treatment of many childhood and adult malignancies. Radiation-induced sarcoma is a well recognized if uncommon event. The objective of this study is to determine the prevalence and long-term outcome for patients who develop radiation-induced sarcomas.Methods: From July 1982 to December 2001, 4884 adult patients with sarcoma were admitted and treated at our institution and recorded in a prospective database. There were 123 (2.5%) patients who had radiation-induced soft tissue sarcomas. Survival was determined by Kaplan-Meier analysis. Patient, tumor, and treatment characteristics were tested for their prognostic significance by log rank and the Cox proportional hazards model.Results: The median interval between radiation and development of sarcoma was 103 (6 to 534) months. In 114 patients with radiation-induced sarcoma who underwent curative resection, the 5-year actuarial survival was 41% with a median Survival of 48 months at a median follow-up of 36 months for survivors. The most common malignancy for which radiation was used was breast cancer (29%), followed by lymphoma (16%) and prostate cancer (15%). Malignant fibrous histiocytoma (23%) was the most common histologic diagnosis, followed by fibrosarcoma (15%) and angiosarcoma (15%). High-grade tumors (n = 85; 79%), age > 60 years (n = 61; 50%), and gross positive resection margin (it = 36; 32%) were predictive of poor sarcoma-specific survival on univariate and multivariate analysis.Conclusions: The increasing utilization of adjuvant radiation therapy, especially for early-stage breast cancer mandates long-term follow-up to detect radiation-induced sarcoma. Surgical resection remains the primary therapy, but 5-year survival remains similar to40%.