Desmoid tumor: Prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy
Desmoid tumor: Prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy
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DOI：
10.1200/jco.1999.17.1.158
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发表时间：
1999-01-01
影响因子：
45.3
通讯作者：
Pollock, RA
中科院分区：
文献类型：
--
作者：
Ballo, MT;Zagars, GK;Pollock, RA
目的：为了评估切除术的治疗价值和潜在的好处和适应症的辅助和明确的放射治疗的硬纤维瘤tumors.Materials和方法：我们进行了回顾性分析189例连续硬纤维瘤手术切除，切除和放射治疗，或单独放射治疗。122例患者仅接受手术治疗，46例患者接受手术和放射治疗，21例患者仅接受放射治疗。结果：总体而言，5年和10年的精算复发率分别为30%和33%，未校正生存率分别为96%，92%和87%，在5年，10年和15年，分别。对于手术治疗的患者，5年和10年的精算复发率分别为34%和38%。在78例切缘阴性患者中，10年复发率为27%，而40例切缘阳性患者的10年复发率为54%（P = 0.003）。肿瘤位于四肢也有一个较差的预后比那些在躯干。对于因严重疾病接受放射治疗的患者，10年精算复发率为24%。对于接受联合切除和放射治疗的患者，10年的精确复发率为25%。此外，放射治疗抵消了不良影响的积极利润率看到在手术group.Conclusion：广泛的局部切除与阴性病理边缘是治疗的选择，大多数硬纤维瘤。保留功能的切除术是合适的，因为辅助放疗可以抵消切缘阳性的不良影响。不可切除的疾病应该用确定的放射疗法治疗。J Clin Oncol 17：158-167。(C)1999年，美国临床肿瘤学会。
Purpose: To evaluate the therapeutic value of resection and the potential benefits of and indications for adjuvant and definitive radiation therapy for desmoid tumors.Materials and Methods: We performed a retrospective review of 189 consecutive cases of desmoid tumor treated with surgical resection, resection and radiation therapy, or radiation therapy alone. Treatment was surgery alone in 122 cases, surgery and radiation therapy in 46, and radiation therapy alone in 21. Median follow-up was 9.4 years.Results: Overall, 5- and 10-year actuarial relapse rates were 30% and 33%, respectively Uncorrected survival rates were 96%, 92%, and 87% at 5, 10, and 15 years, respectively. For the patients treated with surgery, the actuarial relapse rates were 34% and 38% at 5 and 10 years, respectively. Among 78 patients with negative margins, the 10-year recurrence rate was 27%, whereas 40 margin-positive patients had a 10-year relapse rate of 54% (P = .003). Tumors located in an extremity also had a poorer prognosis than did those in the trunk. For patients treated with radiation therapy for gross disease, the 10-year actuarial relapse rate was 24%. For patients treated with combined resection and radiation therapy, the 10-year actuarial relapse rate was 25%. The addition of radiation therapy offset the adverse impact of positive margins seen in the surgical group.Conclusion:Wide local excision with negative pathologic margins is the treatment of choice for most desmoid tumors. Function-sparing resection is appropriate because adjuvant radiation therapy can offset the adverse impact of positive margins. Unresectable disease should be treated with definitive radiation therapy.J Clin Oncol 17:158-167. (C) 1999 by American Society of Clinical Oncology.