术前5 × 5 Gy软组织肉瘤局部衰竭的模式：一个长期的现实世界的经验

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-04-09 DOI:10.1016/j.ctro.2025.100954

Konrad Zasadziński , Aneta Borkowska , Tadeusz Morysiński , Hanna Koseła-Paterczyk , Piotr Rutkowski , Mateusz Jacek Spałek

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引用次数: 0

摘要

术前放疗（RT）用于改善局部控制（LC）和促进局部软组织肉瘤（STS）患者的肢体保留手术。传统的术前放疗以25-28分的剂量提供50-50.4 Gy，替代的低分割方案正在研究中。在STS中研究了5x5 Gy方案，但其长期LC率似乎不是最佳的。本研究的目的是分析5x5 Gy术后局部复发（LR）患者的特点，探讨可能影响疗效的rt相关因素。方法回顾性分析3项临床试验和机构记录中接受5x5 Gy治疗并行局限性四肢和躯干STS手术的患者。评估患者、肿瘤和治疗特点。我们评估了放疗计划的质量和复发模式。结果174例5x5 Gy术后发生LR的患者中，多形性肉瘤（23%）、黏液纤维肉瘤（17.8%）和恶性周围神经鞘瘤（12%）是最常见的病理诊断。黏液样脂肪肉瘤患者未见LR。几乎所有分析的计划都符合质量标准。大多数患者（86.2%）有体积内复发，这表明肿瘤细胞根除不足，而不是边缘不足或靶标覆盖差。剂量等效分析表明，5x5 Gy（假设α / β比为4 Gy， EQD2 = 37.5 Gy）可能不够，特别是对于放射耐药亚型。结论5x5 Gy后发生LR的主要因素是总剂量不足。未来的临床试验应该探索每部分超过5gy的剂量递增，除了黏液样脂肪肉瘤，5x5gy仍然有效。

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A pattern of local failure after preoperative 5 × 5 Gy in soft tissue sarcomas: A long-term real-world experience

Introduction

Preoperative radiotherapy (RT) is used to improve local control (LC) and facilitate limb-sparing procedures in patients with localized soft tissue sarcomas (STS). While conventional preoperative RT delivers 50–50.4 Gy in 25–28 fractions, alternative hypofractionated regimens are under investigation. A 5x5 Gy regimen has been investigated in STS, but its long-term LC rates appear suboptimal. The aim of this study is to analyze the characteristics of patients with local recurrence (LR) after 5x5 Gy and to identify potential RT-related factors affecting efficacy.

Methods

We retrospectively analyzed patients who received 5x5 Gy and underwent surgery for localized extremity and truncal STS in three clinical trials and institutional records. Patient, tumor, and treatment characteristics were evaluated. We assessed the quality of RT plans and recurrence patterns.

Results

Among 174 patients who experienced LR after 5x5 Gy, pleomorphic sarcoma (23 %), myxofibrosarcoma (17.8 %), and malignant peripheral nerve sheath tumor (12 %) were the most common pathologic diagnoses. No LR was observed in patients with myxoid liposarcoma. Almost all analyzed plans met the quality criteria. Most patients (86.2 %) had in-volume recurrences, suggesting inadequate tumor cell eradication rather than insufficient margins or poor target coverage. Dose equivalence analysis suggested that 5x5 Gy (EQD2 = 37.5 Gy for STS, assuming alpha/beta ratio of 4 Gy) may be insufficient, especially for radioresistant subtypes.

Conclusions

The primary factor contributing to LR after 5x5 Gy appears to be insufficient total dose. Future clinical trials should explore dose escalation beyond 5 Gy per fraction, except in myxoid liposarcoma where 5x5 Gy remains effective.

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