Introduction: The prognostic factors for extremity soft-tissue sarcomas (ESTSs) treated with multimodal surgery and radiotherapy (RT) remain a subject of debate across diverse and heterogeneous studies. Methods: We retrospectively analyzed nonmetastatic ESTS patients treated with RT between 2007 and 2020 in Strasbourg, France. We assessed local control (LC), distant control (DC), overall survival (OS), and complications. Results: A total of 169 patients diagnosed with localized ESTS were included. The median age was 64 years (range 21–94 years). ESTS primarily occurred proximally (74.6%) and in the lower limbs (71%). Most tumors were grade 2–3 (71.1%), deep-seated (86.4%), and had R0 margins (63.9%). Most patients were treated with helical tomotherapy (79.3%). The median biologically effective dose (BED) prescribed was 75 BEDGy4(range 45.0–109.9). The median follow-up was 5.5 years. The 5- and 10-year LC, DC, and OS rates were 91.7%, 76.8%, and 83.8% and 84.2%, 74.1%, and 77.6%, respectively. According to the univariate analysis, LC was worse for patients who received less than 75 BEDGy4(p= 0.015). Deep tumors were associated with worse OS (p< 0.05), and grade 2–3 and undifferentiated pleomorphic sarcoma (UPS) were linked to both shorter DC and shorter OS (p< 0.05). IMRT was associated with longer LC than 3DRT (p= 0.018). Multivariate analysis revealed that patients with liposarcoma had better OS (p< 0.05) and that patients with distant relapse had shorter OS (p< 0.0001). Conclusion: RT associated with surgical resection was well tolerated and was associated with excellent long-term rates of LC, DC, and OS. Compared with 3DRT, IMRT improved local control. Liposarcoma was a favorable prognostic factor for OS. Intermediate- and high-grade tumors and deep tumors were associated with lower DC and OS.
引言：对于接受多模式手术和放疗（RT）治疗的肢体软组织肉瘤（ESTS），其预后因素在不同异质性研究中仍存在争议。方法：我们回顾性分析了2007年至2020年间在法国斯特拉斯堡接受放疗的非转移性ESTS患者。评估指标包括局部控制率（LC）、远处控制率（DC）、总生存期（OS）及并发症。结果：共纳入169例确诊为局限性ESTS的患者。中位年龄为64岁（范围21-94岁）。ESTS主要发生于近端（74.6%）及下肢（71%）。多数肿瘤为2-3级（71.1%）、位置深在（86.4%）且切缘为R0（63.9%）。大多数患者接受螺旋断层放疗（79.3%）。处方中位生物有效剂量（BED）为75 BEDGy4（范围45.0-109.9）。中位随访时间为5.5年。5年和10年的LC、DC和OS率分别为91.7%、76.8%、83.8%和84.2%、74.1%、77.6%。单因素分析显示，接受剂量低于75 BEDGy4的患者LC较差（p=0.015）。深部肿瘤与较差的OS相关（p<0.05），而2-3级肿瘤和未分化多形性肉瘤（UPS）与较短的DC和OS均相关（p<0.05）。调强放疗（IMRT）相较于三维适形放疗（3DRT）具有更优的LC（p=0.018）。多因素分析显示，脂肪肉瘤患者OS更佳（p<0.05），而出现远处复发的患者OS更短（p<0.0001）。结论：手术切除联合放疗耐受性良好，且与优异的长期LC、DC和OS率相关。与3DRT相比，IMRT改善了局部控制。脂肪肉瘤是OS的有利预后因素。中高级别肿瘤和深部肿瘤与较低的DC和OS相关。
肿瘤(癌症)患者之家