Two national sarcoma centers have had different approaches for selecting patients with grade 2–3 deep-seated soft tissue sarcomas (STS) for postoperative radiotherapy (RT). We evaluated potential differences in local recurrence in patients treated at the two centers. At Sarcoma Center 1 (SC1), RT was the standard treatment for all tumors except certain small tumors excised with a margin wider than 1 cm. Sarcoma Center 2 (SC2) avoided RT for tumors regardless of tumor size if removed with a margin wider than 1 cm and/or a solid barrier. We included 386 patients (SC1/SC2 = 196/190) over 18 years of age diagnosed with a non-metastatic grade 2–3, deep-seated STS of the extremities or trunk wall, who underwent primary surgical treatment (only tumors excised with a negative margin) from 1 January 2000, to 31 December 2016. Kaplan–Meier survival analysis, competing risk analysis, and cause-specific Cox regression were applied. A total of 284 patients received primary RT, 163 (83%) at SC1 and 121 (64%) at SC2 (p< 0.001). The cumulative incidence of local recurrence at five years was 15% (95% CI: 10–19%) at SC1 and 14% (95% CI: 9–19%) at SC2. Multivariate analysis showed no significant differences in local recurrence between the centers. We concluded that when entering all available patients into the analysis using an intention-to-treat principle, a more selective approach to postoperative RT in patients with grade 2–3 deep-seated STS did not lead to a higher local recurrence rate. However, with this study design, we cannot rule out if the local recurrence rate could have been lower if RT was administered to all tumors removed with a margin wider than 1 cm and/or a solid barrier.
两家国家级肉瘤中心在筛选2-3级深部软组织肉瘤患者接受术后放疗方面采取了不同策略。本研究评估了两中心治疗患者局部复发率的潜在差异。在肉瘤中心1，除部分切除边界超过1厘米的小型肿瘤外，放疗是所有肿瘤的标准治疗方案。肉瘤中心2则对切除边界超过1厘米和/或存在实体屏障的肿瘤（无论肿瘤大小）均避免使用放疗。研究纳入2000年1月1日至2016年12月31日期间接受初次手术治疗（仅纳入切除边界阴性的肿瘤）的386例患者（SC1/SC2=196/190），患者年龄≥18岁，诊断为四肢或躯干壁非转移性2-3级深部软组织肉瘤。采用Kaplan-Meier生存分析、竞争风险分析和病因特异性Cox回归进行分析。共有284例患者接受初次放疗，其中SC1中心163例（83%），SC2中心121例（64%）（p<0.001）。五年累积局部复发率在SC1为15%（95%CI：10-19%），在SC2为14%（95%CI：9-19%）。多变量分析显示两中心间局部复发率无显著差异。结论：采用意向治疗原则将所有可用患者纳入分析时，对2-3级深部软组织肉瘤患者采取更具选择性的术后放疗策略并未导致更高的局部复发率。但本研究设计无法排除以下可能性：若对所有切除边界超过1厘米和/或存在实体屏障的肿瘤均实施放疗，局部复发率或可进一步降低。
肿瘤(癌症)患者之家