术后放射治疗在原发肢体软组织肉瘤治疗中的作用

分析本院收治的原发于肢体的软组织肉瘤的治疗情况 ,评价术后放射治疗的作用。方法　本院共收治 15 1例 ,可供分析的 139例 ,分析影响生存和局控的因素及术后放射治疗的意义。生存率和局控率用Kaplan Meier方法计算 ,单因素分析用Logrank检验 ,多因素分析用Cox回归方法。结果　全组 5年生存率为 70 .2 % ,10年为 5 0 .4% ;5年无瘤生存率为 5 2 .9% ,10年为41.2 %。单因素分析对全组病例生存率有影响的因素 :肿瘤大小、年龄和治疗方式 (P值分别为0 .0 0 8,0 .0 0 7和 0 .0 40 )。多因素分析只有治疗方式对生存有影响 (P =0 .0 40 )。首次治疗方式对局控影响差异有极显著性 (P <0 .0 1)。手术方式对单纯手术组局控影响差异有极显著性 (P <0 .0 1) ;肿瘤 <5cm时 ,射野大小对术后放射治疗组局控影响差异有极显著性 (P <0 .0 1)。结论　术后放射治疗能提高局部控制率 ,初始射野应相对大 ,并采用缩野技术。对恶性度低、肿瘤 <5cm、手术切缘阴性患者第 1次术后可不做放射治疗。

Postoperative radiotherapy for primary soft tissue sarcoma of the extremities.

Objective To evaluate the role of postoperative radiotherapy for pprimary soft tissue sarcoma of the extremities.Methods From January 1984 to December 1994, 151 patients were retrospectively reviewed, and 139 of them were eligible to analyze the effect of tumor size, treatment modality and postoperative radiotherapy on survival and local control. Kaplan-Meier method was used to calculate the survival and local control rates. The differences between these two groups were evaluated by Logrank test and Cox regression model was used for multivariate analysis. Results The overall survivals at 5- and 10-year were 70.2% and 50.4%, respectively. The corresponding disease free survivals were 52.9% and 41.2%, respectively. The tumor size, age, and treatment modalities were important prognostic factors when analyzed by univariate factor. The treatment modality was only a prognostic factor when analyzed by multivariate analysis (P=0.04). The primary treatment modality had significant effect on local control (P< 0.01). For patients with the primary tumor less than 5 cm, radiation volume had significant effect on local control. Conclusions Postoperative radiotherapy increases the local control rate. We suggest the use of extended radiation field and the cone-down technique. Radiotherapy following resection is unnecessary when the primary tumor is low grade and less than 5 cm in size and surgical margin is negative.