软组织肉瘤术后放射治疗及其预后分析

Postoperative radiotherapy and prognostic factors of soft tissue sarcoma

目的 分析软组织肉瘤术后放射治疗的疗效和预后因素。方法 6 4例软组织肉瘤经部分切除、完整切除和扩大切除术后接受体外放射治疗 ,其中常规分割放射治疗 48例 (1.8～ 2 .0Gy 次 ,5次 周 ,DT40～ 72Gy ,中位剂量 6 0Gy) ,超分割放射治疗 16例 (1.2～ 1.5Gy 次 ,2次 d ,间隔 6h ,DT6 4.8～ 85 .0Gy,中位剂量 6 6 .5Gy)。采用Kaplan Meier法计算 5年生存率并经Logrank检验 ,采用Cox回归分析预后因素的统计学意义。结果 全组 5年生存率、局部控制率分别为 6 0 .2 %、5 7.9% ;其中常规分割组与超分割组分别为 5 4.3%、6 1.9%和 6 4.3%、42 .9%。多因素回归分析显示组织学分级、病变大小、病变部位、分割方式是影响生存率的独立预后因素。结论 软组织肉瘤经完整或扩大切除术加术后放射治疗可以获得良好疗效 ,组织学分级、病变大小、病变部位。

Objective To study the effectiveness of postoperative radiotherapy and prognostic factors of soft tissue sarcoma. Methods Sixty-four soft tissue sarcoma patients admitted from June 1987 to May 1997 were treated by complete,partial or extended resection and postoperative external beam radiotherapy. Fourty-eight patients received 1.8～2.0?Gy/fraction,5 f/w, to a dose of 40～72?Gy (median 60?Gy). Sixteen patients received 1.2～1.5?Gy/f, bid, 6 hr interval to a dose of 64.8～85.0?Gy (median 66.5?Gy). The 5-year survival and locoregional control rates were estimated by Kaplan-Meier method. Logrank test and Cox regression were used to study the significance of predictive factors. Results The overall 5-year survival and locoregional control rates were 60.2%, 57.9% respectively. Those of the conventional group and hyperfractionated group were 54.3% and 61.9% vs 64.3% and 42.9% ,respectively. Cox regression analysis showed that histologic grade, size and site of the primary tumor, fractionation of radiotherapy were independent prognostic factors for survival. Conclusions Complete or extended resection followed by radiotherapy are satisfactory for soft tissue sarcoma. Histologic grade , size, site of the primary tumor and method of fractionation were prognostic factors.