肢体和躯干体壁软组织肉瘤患者术后IMRT疗效分析

Therapeutic effect of postoperative intensity-modulated radiotherapy in patients with soft tissue sarcomas of the extremities and trunk wall

目的分析术后IMRT对肢体和躯干软组织肉瘤患者疗效。方法回顾分析2005—2011年收治的80例肢体和躯干体壁软组织肉瘤患者资料。全组患者功能保全手术后均行IMRT，其中原发肢体的51例，原发躯干体壁的29例。7l例患者获得阴性手术切缘。中位放疗剂量为64Gy。Kaplan—Meier法计算生存率并Logrank法检验，Cox模型多因素预后分析。结果5年样本数为43例，5年LC率为88％、DMFS率为75％、PFS率为73％、OS率为84％。手术切缘阴性者5年LC率显著高于阳性切缘者（90％比65％。P=0．023），原发肿瘤≤5cm者的5年OS率显著高于〉5cm者（95％比69％．P=0．041）。多因素分析显示阳性切缘是LC率的影响因素（HR=5．33，95％ CI为1．19～23．86，P=0．029）。随访期间水肿和关节僵硬总发生率分别为18％和10％。结论肢体和躯干体壁软组织肉瘤患者行术后IMRT可获得良好Lc率，远期不良反应发生率低。

Objective To investigate the therapeutic effect of postoperative intensity-modulated radiotherapy （IMRT） in patients with soft tissue sarcomas （STSs） of the extremities and trunk wall. Methods The clinical data of 80 patients with STSs of the extremities and trunk wall who were admitted and treated from 2005 to 2011 were analyzed retrospectively. All the patients received postoperative IMRT after conservation surgery, among whom 51 patients had primary lesions in the extremities and 29 had primary lesions in the trunk wall. Seventy-one patients achieved negative resection margin. The median dose of IMRT was 64 Gy. The Kaplan-Meier method was applied to calculate survival rates, the log-rank test was used for survival difference analysis, and the Cox proportional hazards model was applied for multivariate prognostic analysis. Results The 5-year sample size was 43. The 5-year local control （LC） rate, distant metastasis- free survival rate, progression-free survival rate, and 5-year overall survival （OS） rate were 88%, 75%, 73%, and 84%, respectively. The patients with negative resection margin had a significantly higher 5-year LC rate than those with positive resection margin （90% vs. 65%, P= 0. 023）. The patients with primary tumor ≤ cm has a significantly higher 5-year OS rate than those with primary tumor〉5 cm （95% vs. 69%,P=0.041）,multivariate.analysis revealed that positive resection margin was an independent risk factor for LC rate（HR=3.33,95% CI 1.19-23.86, P= 0. 029）. During follow-up, the overall incidence rates of adema and joint steffess were 18% and 10%, respectively. Conclusions Patients with STSs of the extremities and trund wall can achieve a high LC rate after postoperative IMRT, with low incidence rates of hong-term adverse events.