Background: In soft tissue or bone sarcomas, multimodal therapeutic concepts represent the standard of care. Some patients reject the therapeutic recommendations due to several reasons. The aim of this study was to assess the impact of that rejection on both prognosis and local recurrence. Methods: Between 2012 and 2019, a total of 828 sarcoma patients were surgically treated. Chemotherapy was scheduled as a neoadjuvant, and adjuvant multi-agent therapy was performed following recommendations from an interdisciplinary tumor board. Radiotherapy, if deemed appropriate, was administered either in a neoadjuvant or an adjuvant manner. The recommended type of therapy, patient compliance, and the reasons for refusal were documented. Follow-ups included local recurrences, diagnosis of metastatic disease, and patient mortality. Results: Radiotherapy was recommended in 407 (49%) patients. A total of 40 (10%) individuals did not receive radiation. A reduction in overall survival and local recurrence-free survival was evident in those patients who declined radiotherapy. Chemotherapy was advised for 334 (40%) patients, 250 (75%) of whom did receive all recommended cycles. A total of 25 (7%) individuals did receive a partial course while 59 (18%) did not receive any recommended chemotherapy. Overall survival and local recurrence-free survival were reduced in patients refusing chemotherapy. Overall survival was worst for the group of patients who received no chemotherapy due to medical reasons. Refusing chemotherapy for non-medical reasons was seen in 8.8% of patients, and refusal of radiotherapy for non-medical reasons was seen in 4.7% of patients. Conclusions: Divergence from the advised treatment modalities significantly impacted overall survival and local recurrence-free survival across both treatment modalities. There is an imperative need for enhanced physician-patient communication. Reducing treatment times, as achieved with hypofractionated radiotherapy and with therapy in a high-volume sarcoma center, might also have a positive effect on complying with the treatment recommendations.
背景：在软组织或骨肉瘤的治疗中，多模式综合治疗方案已成为标准治疗策略。部分患者因多种原因拒绝接受推荐的治疗方案。本研究旨在评估此类拒绝行为对患者预后及局部复发率的影响。方法：2012年至2019年间，共有828例肉瘤患者接受手术治疗。根据多学科肿瘤委员会的建议，化疗采用新辅助化疗方案，术后实施辅助性多药联合治疗。放疗若适用，则采用新辅助或辅助方式进行。研究记录了推荐治疗方案类型、患者依从性及拒绝治疗的原因。随访内容包括局部复发、转移性疾病诊断及患者死亡率。结果：407例（49%）患者被建议接受放疗，其中40例（10%）未接受放射治疗。拒绝放疗的患者总体生存率和无局部复发生存率显著降低。334例（40%）患者被建议接受化疗，其中250例（75%）完成全部推荐周期，25例（7%）接受部分疗程，59例（18%）未接受任何推荐化疗。拒绝化疗患者的总体生存率和无局部复发生存率明显下降。因医学原因完全未接受化疗的患者组总体生存率最差。非医学原因拒绝化疗者占8.8%，非医学原因拒绝放疗者占4.7%。结论：偏离推荐治疗方案会显著影响两种治疗方式的总体生存率和无局部复发生存率。亟需加强医患沟通。通过大分割放疗及在高接诊量肉瘤中心进行治疗可缩短疗程，可能对提高治疗依从性产生积极影响。
肿瘤(癌症)患者之家