Siyer Roohani MD, Anthony M. Griffin MSc, Zhihui Amy Liu PhD, Charles N. Catton MD, Colleen I. Dickie MSc, Peter C. Ferguson MD, David G. Kirsch MD, PhD, Brian O’Sullivan MD, David B. Shultz MD, PhD, Kim M. Tsoi MD, PhD, Philip Wong MD, MSc, Jay S. Wunder MD, Peter W. M. Chung MD
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Chung MD","doi":"10.1002/cncr.70049","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The objective of this study was to evaluate whether dosimetric sparing of uninvolved normal tissues, including skin/subcutaneous <i>flaps</i>, affects acute and late toxicities in preoperative image-guided intensity-modulated radiation therapy (IG-IMRT) for lower extremity soft tissue sarcomas (LE-STS).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Patients with LE-STS from a phase 2 preoperative IG-IMRT trial (flap-sparing-IMRT, 2005–2009) and a prospectively maintained institutional database (standard-IMRT, 2005–2020) were propensity matched by age, sex, tumor size, grade, location, wound closure, and interval from IG-IMRT to surgery; all received 50 Gy in 25 fractions preoperatively. The primary outcome was major wound complication (MWC). 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引用次数: 0
摘要
本研究的目的是评估术前图像引导下调强放疗（IG-IMRT）治疗下肢软组织肉瘤（LE-STS）的急性和晚期毒性是否影响未受影响的正常组织（包括皮肤/皮下皮瓣）的剂量节约。方法术前2期IG-IMRT试验（皮瓣-保留- imrt， 2005-2009）和前瞻性维护的机构数据库（标准- imrt， 2005-2020）的LE-STS患者在年龄、性别、肿瘤大小、分级、位置、伤口愈合和IG-IMRT至手术间隔方面进行倾向匹配；术前25次接受50 Gy放疗。主要结局为主要伤口并发症（MWC）。次要结果是晚期放射治疗肿瘤组毒性、功能评分（多伦多肢体挽救评分[TESS]；肌肉骨骼肿瘤协会评分[MSTS-87或MSTS-93]）和肿瘤学结果。Kaplan-Meier估计、累积关联函数、线性回归、逻辑回归和Cox回归（视情况而定）。结果55例接受皮瓣保留- imrt的患者与275例接受标准- imrt的患者的比例为1:5（中位随访时间分别为104个月和56个月）。回归分析发现，治疗技术与mwc （29% vs. 27%；比值比0.92;p = 0.77）、2级或以上晚期毒性：皮下纤维化（15% vs. 8%）、关节僵硬（5% vs. 2%）、水肿（11% vs. 10%）、骨折（2% vs. 4%）或功能结局（TESS, 87 vs. 89; MSTS-87, 33 vs. 33; MSTS-93, 93 vs. 97；所有p >； 1）之间无显著关联。5年总生存率（83.6%比75.2%）、无病生存率（65.5%比64.1%）、局部复发（5.2%比7.3%）、远处转移（29.1%比30.1%）也具有可比性（p > 1）。结论：与LE-STS患者的标准imrt相比，保留皮瓣的imrt特异性避免了未受损伤的皮肤/皮下组织，在MWCs、晚期毒性、功能和肿瘤预后方面差异极小。
Preoperative intensity-modulated radiation therapy in lower extremity soft tissue sarcomas with and without dose avoidance of uninvolved skin/subcutaneous tissue
Background
The objective of this study was to evaluate whether dosimetric sparing of uninvolved normal tissues, including skin/subcutaneous flaps, affects acute and late toxicities in preoperative image-guided intensity-modulated radiation therapy (IG-IMRT) for lower extremity soft tissue sarcomas (LE-STS).
Methods
Patients with LE-STS from a phase 2 preoperative IG-IMRT trial (flap-sparing-IMRT, 2005–2009) and a prospectively maintained institutional database (standard-IMRT, 2005–2020) were propensity matched by age, sex, tumor size, grade, location, wound closure, and interval from IG-IMRT to surgery; all received 50 Gy in 25 fractions preoperatively. The primary outcome was major wound complication (MWC). Secondary outcomes were late Radiation Therapy Oncology Group toxicities, functional scores (Toronto Extremity Salvage Score [TESS]; Musculoskeletal Tumor Society scales [MSTS-87 or MSTS-93]), and oncologic outcomes. Kaplan–Meier estimates, cumulative incidence functions, and linear, logistic, and Cox regression were used, as appropriate.
Results
Fifty-five patients who received flap-sparing-IMRT were 1:5 matched to 275 patients who received standard-IMRT (median follow-up, 104 vs. 56 months, respectively). Regression analyses identified no significant association between treatment technique and MWCs (29% vs. 27%; odds ratio, 0.92; p = .77), late grade 2 or greater toxicities: subcutaneous fibrosis (15% vs. 8%), joint stiffness (5% vs. 2%), edema (11% vs. 10%), fracture (2% vs. 4%), or functional outcomes (TESS, 87 vs. 89; MSTS-87, 33 vs. 33; and MSTS-93, 93 vs. 97; all p > .1). Five-year overall survival (83.6% vs. 75.2%), disease-free survival (65.5% vs. 64.1%), local recurrence (5.2% vs. 7.3%), distant metastasis (29.1% vs. 30.1%) were also comparable (p > .1).
Conclusions
Flap-sparing-IMRT with specific avoidance of uninvolved skin/subcutaneous tissues demonstrated minimal differences in MWCs, late toxicity, and functional and oncologic outcomes compared with standard-IMRT in patients with LE-STS.
期刊介绍：
The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society.
CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research
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