33例接受术前放疗的局部高危软组织肉瘤患者近期疗效和安全性回顾性分析

Retrospective analysis of short-term efficacy and safety of preoperative radiotherapy for 33 cases of locally high-risk soft tissue sarcoma

背景与目的:对于局部高危软组织肉瘤,单纯手术治疗常常不能获得满意效果。本研究旨在评估术前放疗联合手术用于治疗局部高危软组织肉瘤患者的近期疗效和安全性。方法:回顾性分析2021年2月—2022年6月在复旦大学附属肿瘤医院接受术前放疗的连续性患者的临床资料,包括临床特征、放疗方案、影像学资料及病理学资料等。放疗的靶区勾画采用图像融合技术,将磁共振成像(magnetic resonance imaging,MRI)图像融合至模拟定位计算机体层成像(computed tomography,CT)图像上,勾画靶区时逐层参考。所有患者均接受调强适形放疗(intensity-modulated radiotherapy,IMRT)技术制订的放疗计划。计数资料采用百分数表示。分析影像学应答(完全缓解、部分缓解、疾病稳定、疾病进展、客观缓解及疾病控制)比例、病理学应答[接近病理学完全缓解(near-pathologic complete response,near-pCR),定义为≥90%的无活性肿瘤细胞]比例及毒性反应(急性皮肤损伤和术后120 d内伤口并发症)比例。结果:共41例患者在术前接受了放疗,其中33例患者符合纳入标准:31例可进行影像学评估,28例可进行病理学评估。患者的中位年龄为53岁,30例(90.9%)患者的肿瘤组织学分级为3级。影像学分析提示,6例(19.4%)患者获得部分缓解,1例患者出现疾病进展,无人获得完全缓解,客观缓解率为19.4%,疾病控制率为96.8%。病理学分析提示,8例(28.6%)患者near-pCR;排除既往接受过化疗的患者,near-pCR率为34.8%(8/23)。33.3%(11/33)和3.0%(1/33)患者出现1和2级皮肤损伤,未发生3和4级皮肤损伤。1例(3.3%)患者出现术后120 d内的严重伤口并发症。结论:利用MRI图像融合技术和IMRT技术的术前放疗对于局部高危软组织肉瘤患者,近期疗效良好,急性毒性反应可接受。

Background and purpose:Surgery alone is not enough to get satisfied outcome for locally high-risk soft tissue sarcoma(STS).We retrospectively assessed the short-term efficacy and safety of preoperative radiotherapy followed by surgery in patients with locally high-risk STS.Methods:Data from consecutive patients treated with preoperative radiotherapy at Fudan University Shanghai Cancer Center from February 2021 to June 2022 were reviewed.The data included clinical characteristics,radiotherapy regimes,radiological images and pathology slides.The target volumes of radiotherapy were delineated on computed tomography(CT)simulation images with reference to fused magnetic resonance imaging(MRI)images slides by slides.All the patients received radiotherapy planned with intensity-modulated radiotherapy(IMRT).Counting data was presented as percentages.The rates of radiological response(complete response,partial response,stable disease,progressive disease,objective response and disease control),pathological response[near-pathologic complete response(near-pCR),defined as≥90%non-viable tumor cells]and toxicities(acute skin toxicity and major wound complications occurring within 120 d of surgery)were analyzed.Results:Forty-one patients received radiotherapy before surgery,among them 33 patients were eligible:31 for radiological assessment and 28 for pathological assessment.The median age was 53 years.Thirty(90.0%)cases were histologically classified as Grade 3.Six(19.4%)patients achieved partial response,and 1 patient had progressive disease after radiotherapy.None got complete response.The objective response rate was 19.4%,and the disease control rate was 96.8%.Near-pCR was found in 8(28.6%)patients.Excluding patients receiving chemotherapy previously,the near-pCR rate was 34.8%(8/23).Grade 1 and 2 skin injuries were found on 33.3%(11/33)and 3.0%(1/33)patients.No grade 3 and 4 skin injury occurred.Major wound complications within 120 d of surgery occured in 1(3.3%)patient.Conclusion:Preoperative radiotherapy facilitated with fused MRI images and IMRT has good short-term efficacy and tolerable acute toxicities for locally high-risk STS.