BibTex RIS Kaynak Göster

Prognostic factors in soft tissue sarcoma patients treated with postoperative radiotherapy

Yıl 2006, Cilt: 21 Sayı: 3, 119 - 124, 01.04.2006

Öz

OBJECTIVES Prognostic factors were studied in 53 patients with soft tissue sarcoma treated with postoperative radiotherapy in Dokuz Eylül University Department of Radiation Oncology during the period November 1991-March 2003. METHODS Thirty of the patients (57%) were male. Median age was 38 (18-80). Thirty-three patients (62%) received their first diagnostic or surgical procedure in Dokuz Eylül University while the rest were referred from other institutions for postoperative radiotherapy. Tumor localization was as follows: 36 (68%) lower extremity, 6 (11%) upper extremity, 5 (10%) trunk, 6 (11%) head and neck. Twenty-nine patients (55%) had grade 1-2 tumors while 10 patients (19%) had grade 3 tumors. Histological grade could not be determined in 14 (26%) patients. Surgery was performed as wide excision, marginal or intralesional excision and excisional biopsy in 30 (57%), 15 (28%), and 8 (15%) patients, respectively. Surgical margins were reported as negative in 29 patients (55%). Gross residue was present in 15 patients (28%). Pathological tumor size was median 80 mm (15-220). Postoperative radiotherapy was given using two parallel opposed fields with Co 60 or 6 MVX photon energies. Median total radiotherapy dose was 6600 (4040-7500) cGy and median fraction dose was 200 (160-250) cGy. Adjuvant chemotherapy was added after postoperative radiotherapy in 14 patients who had high grade tumors and/or large tumor size. Survival times were calculated with Kaplan-Meier method considering the periods from the time of diagnosis. To find out prognostic factors, log-rank test and Cox regression test were applied in univariate and multivariate analyses, respectively. RESULTS Local control could not be achieved in 12 cases. Fifteen patients developed distant metastasis during follow-up. Five-year overall survival (OS) was 58%, respectively. In the multivariate analysis, OS was found to be independently influenced from tumor size

Kaynakça

  • 1. Popov P, Tukiainen E, Asko-Seljaavaara S, Huuhtanen R, Virolainen M, Virkkunen P, et al. Soft tissue sarcomas of the lower extremity: surgical treatment and outcome. Eur J Surg Oncol 2000;26(7):679-85.
  • 2. Ballo MT, Zagars GK, CormierJN, Hunt KK, Feig BW, Patel SR, et al. Interval between surgery and radiotherapy: effect on local control of soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2004;58(5):1461-7.
  • 3. Baldini EH, Goldberg J, Jenner C, Manola JB, Demetri GD, Fletcher CD, et al. Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol 1999;17(10):3252-9.
  • 4. Lewis JJ, Leung D, Heslin M, Woodruff JM, Brennan MF. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 1997;15(2):646-52.
  • 5. Karakousis CP, Driscoll DL. Treatment and local control of primary extremity soft tissue sarcomas. J Surg Oncol 1999;71(3):155-61.
  • 6. Rougraff B. Surgery for local control of soft tissue sar coma. In: The Diagnosis and Management of Soft Tissue Sarcomas of the Extremities in the Adult. Curr Prob Cancer 1999; 23:23-38.
  • 7. Khanfir K, Alzieu L, Terrier P, Le Pechoux C, Bonvalot S, Vanel D, et al. Does adjuvant radiation therapy increase loco-regional control after optimal resection of soft-tissue sarcoma of the extremities? Eur J Cancer 2003;39(13):1872-80.
  • 8. Kaytan E, Yaman F, Cosar R, Eralp Y, Saip P, Darendeliler E. Prognostic factors in localized soft-tissue sarcomas. Am J Clin Oncol 2003;26(4):411-5.
  • 9. Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS. Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer 2003;97(10):2544-53.
  • 10. Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996;14(5):1679-89.
  • 11. Heslin MJ, Woodruff J, Brennan MF. Prognostic significance of a positive microscopic margin in highrisk extremity soft tissue sarcoma: implications for management. J Clin Oncol 1996;14(2):473-8.
  • 12. Andrews SF, Anderson PR, Eisenberg BL, Hanlon AL, Pollack A. Soft tissue sarcomas treated with postoperative external beam radiotherapy with and without low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2004;59(2):475-80.
  • 13. Peiper M, Zurakowski D, Knoefel WT, Izbicki JR. Malignant fibrous histiocytoma of the extremities and trunk: an institutional review. Surg e r y 2004;135(1):59-66.
  • 14. Youssef E, Fontanesi J, Mott M, Kraut M, Lucas D, Mekhael H, et al. Long-term outcome of combined modality therapy in retroperitoneal and deep-trunk soft-tissue sarcoma: analysis of prognostic factors. Int J Radiat Oncol Biol Phys 2002;54(2):514-9.
  • 15. Stotter AT, A'Hern RP, Fisher C, Mott AF, Fallowfield ME, Westbury G. The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival. Cancer 1990;65(5):1119-29.
  • 16. Singer S, Corson JM, Gonin R, Labow B, Eberlein TJ. Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 1994;219(2):165-73.
  • 17. Ueda T, Yoshikawa H, Mori S, Araki N, Myoui A, Kuratsu S, et al. Influence of local recurrence on the prognosis of soft-tissue sarcomas. J Bone Joint Surg [Br] 1997;79(4):553-7.
  • 18. Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 225 patients. Cancer 2003;97(10):2530-43.
  • 19.Ramanathan RC, A'Hern R, Fisher C, Thomas JM. Prognostic index for extremity soft tissue sarcomas with isolated local recurrence. Ann Surg Oncol 2001;8(4):278-89.
  • 20. Herbert SH, Corn BW, Solin LJ, Lanciano RM, Schultz DJ, McKenna WG, et al. Limb-preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical margins. Cancer 1993;72(4):1230-8.
  • 21. Trovik CS, Bauer HC, Alvegard TA, Anderson H, Blomqvist C, Berlin O, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 s u rgically-treated patients from the Scandinavian Sarcoma Group Register. Eur J Cancer 2000;36(6):710-6.
  • 22. Vraa S, Keller J, Nielsen OS, Jurik AG, Jensen OM. Soft-tissue sarcoma of the thigh: surgical margin influences local recurrence but not survival in 152 patients. Acta Orthop Scand 2001;72(1):72-7.
  • 23.R o s e n b e rg SA, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982;196(3):305-15.
  • 24.Brennan MF, Hilaris B, Shiu MH, Lane J, Magill G, Friedrich C, et al. Local recurrence in adult soft-tissue sarcoma. A randomized trial of brachytherapy. Arch Surg 1987;122(11):1289-93.
  • 25.Collin C, Godbold J, Hajdu S, Brennan M. Localized extremity soft tissue sarcoma: an analysis of factors affecting survival. J Clin Oncol 1987;5(4):601-12.
  • 26.Rantakokko V, Ekfors TO. Sarcomas of the soft tissues in the extremities and limb girdles. Analysis of 240 cases diagnosed in Finland in 1960-1969. Acta Chir Scand 1979;145(6):384-94.
  • 27. Coindre JM, Terrier P, Bui NB, Bonichon F, Collin F, Le Doussal V, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 1996;14(3):869-77.
  • 28.[No authors listed] Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Metaanalysis Collaboration. Lancet 1997;350(9092):1647- 54.
  • 29. Gherlinzoni F, Bacci G, Picci P, Capanna R, Calderoni P, Lorenzi EG, et al. A randomized trial for the treatment of high-grade soft-tissue sarcomas of the extremities: preliminary observations. J Clin Oncol 1986;4(4):552-8.
  • 30. Frustaci S, Gherlinzoni F, De Paoli A, et al. Maintainance of efficacy of adjuvant chemotherapy in soft tissue sarcoma of the extremities. Update of a randomized trial. Proc Am Soc Clin Oncol 1999;18:A2108.

Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler

Yıl 2006, Cilt: 21 Sayı: 3, 119 - 124, 01.04.2006

Öz

AMAÇ Dokuz Eylül Üniversitesi Tıp Fakültesi (DEÜTF) Radyasyon Onkolojisi Kliniğinde Kasım 1991-Mart 2003 tarihleri arasında ameliyat sonrası radyoterapi (RT) verilen 53 yumuşak doku sarkomlu olguda tedavi sonuçları ve prognostik faktörlerin incelenmesi amaçlandı. GEREÇ VE YÖNTEM Ameliyat sonrası RT gören ve tanı anında uzak metastazı olmayan 53 olgunun 30'u (%57) erkekti. Medyan yaş 38 (18-80) idi. Hastaların 33'üne (%62) DEÜTF'de ilk tanısal veya cerrahi girişim uygulanmış olup 20'si (%38) ise DEÜTF dışı kurumlardan RT için gönderilmişlerdi. Yumuşak doku sarkomlu olgularda tümör yerleşimi 36 (%68) alt ekstremite, 6 (%11) üst ekstremite, 5 (%10) gövde, 6 (%11) baş-boyun şeklinde idi. Histolojik derece dağılımına göre 29 (%55) olgu derece 1, 2; 10 (%19) olgu derece 3 olup hastaların 14'ünde (%26) ise derece belirlenemedi. Cerrahi, 30 (%57) hastada geniş eksizyon, 15 (% 28) hastada marjinal veya intralezyonel eksizyon, 8 (%15) hastada ise eksizyonel biyopsi olarak uygulanmıştı. Hastaların 29'unun (%55) patoloji raporunda cerrahi sınırlar negatif idi. Makroskobik kalıntı ise olguların 15'inde (%28) vardı. Patolojik tümör boyutu medyan 80 mm (15-220) idi. Ameliyat sonrası RT karşılıklı paralel iki alan kullanılarak Co 60 veya 6 MVX foton enerjileri ile verildi. Medyan RT total dozu 6600 (4040-7500) cGy ve medyan fraksiyon dozu ise 200 (160- 250) cGy idi. Yüksek derece ve/veya tümör boyutunun büyüklüğü nedeniyle 14 olguda ameliyat sonrası RT ardından adjuvan kemoterapi eklendi. Sağkalımlar başlangıç noktası tanı zamanı alınarak Kaplan- Meier yöntemi ile hesaplandı. Prognostik faktörleri bulmak için yapılan tek değişkenli analizde log-rank testi, çok değişkenli analizde ise Cox-regresyon testi uygulandı. BULGULAR Olguların 12'sinde yerel kontrol sağlanamadı. Hastaların 15'inde sonradan uzak metastaz ortaya çıktı. Beş yıllık genel sağkalım %58 idi. Çok değişkenli analiz yapıldığında; genel sağkalım için

Kaynakça

  • 1. Popov P, Tukiainen E, Asko-Seljaavaara S, Huuhtanen R, Virolainen M, Virkkunen P, et al. Soft tissue sarcomas of the lower extremity: surgical treatment and outcome. Eur J Surg Oncol 2000;26(7):679-85.
  • 2. Ballo MT, Zagars GK, CormierJN, Hunt KK, Feig BW, Patel SR, et al. Interval between surgery and radiotherapy: effect on local control of soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2004;58(5):1461-7.
  • 3. Baldini EH, Goldberg J, Jenner C, Manola JB, Demetri GD, Fletcher CD, et al. Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol 1999;17(10):3252-9.
  • 4. Lewis JJ, Leung D, Heslin M, Woodruff JM, Brennan MF. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 1997;15(2):646-52.
  • 5. Karakousis CP, Driscoll DL. Treatment and local control of primary extremity soft tissue sarcomas. J Surg Oncol 1999;71(3):155-61.
  • 6. Rougraff B. Surgery for local control of soft tissue sar coma. In: The Diagnosis and Management of Soft Tissue Sarcomas of the Extremities in the Adult. Curr Prob Cancer 1999; 23:23-38.
  • 7. Khanfir K, Alzieu L, Terrier P, Le Pechoux C, Bonvalot S, Vanel D, et al. Does adjuvant radiation therapy increase loco-regional control after optimal resection of soft-tissue sarcoma of the extremities? Eur J Cancer 2003;39(13):1872-80.
  • 8. Kaytan E, Yaman F, Cosar R, Eralp Y, Saip P, Darendeliler E. Prognostic factors in localized soft-tissue sarcomas. Am J Clin Oncol 2003;26(4):411-5.
  • 9. Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS. Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer 2003;97(10):2544-53.
  • 10. Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996;14(5):1679-89.
  • 11. Heslin MJ, Woodruff J, Brennan MF. Prognostic significance of a positive microscopic margin in highrisk extremity soft tissue sarcoma: implications for management. J Clin Oncol 1996;14(2):473-8.
  • 12. Andrews SF, Anderson PR, Eisenberg BL, Hanlon AL, Pollack A. Soft tissue sarcomas treated with postoperative external beam radiotherapy with and without low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2004;59(2):475-80.
  • 13. Peiper M, Zurakowski D, Knoefel WT, Izbicki JR. Malignant fibrous histiocytoma of the extremities and trunk: an institutional review. Surg e r y 2004;135(1):59-66.
  • 14. Youssef E, Fontanesi J, Mott M, Kraut M, Lucas D, Mekhael H, et al. Long-term outcome of combined modality therapy in retroperitoneal and deep-trunk soft-tissue sarcoma: analysis of prognostic factors. Int J Radiat Oncol Biol Phys 2002;54(2):514-9.
  • 15. Stotter AT, A'Hern RP, Fisher C, Mott AF, Fallowfield ME, Westbury G. The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival. Cancer 1990;65(5):1119-29.
  • 16. Singer S, Corson JM, Gonin R, Labow B, Eberlein TJ. Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 1994;219(2):165-73.
  • 17. Ueda T, Yoshikawa H, Mori S, Araki N, Myoui A, Kuratsu S, et al. Influence of local recurrence on the prognosis of soft-tissue sarcomas. J Bone Joint Surg [Br] 1997;79(4):553-7.
  • 18. Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 225 patients. Cancer 2003;97(10):2530-43.
  • 19.Ramanathan RC, A'Hern R, Fisher C, Thomas JM. Prognostic index for extremity soft tissue sarcomas with isolated local recurrence. Ann Surg Oncol 2001;8(4):278-89.
  • 20. Herbert SH, Corn BW, Solin LJ, Lanciano RM, Schultz DJ, McKenna WG, et al. Limb-preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical margins. Cancer 1993;72(4):1230-8.
  • 21. Trovik CS, Bauer HC, Alvegard TA, Anderson H, Blomqvist C, Berlin O, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 s u rgically-treated patients from the Scandinavian Sarcoma Group Register. Eur J Cancer 2000;36(6):710-6.
  • 22. Vraa S, Keller J, Nielsen OS, Jurik AG, Jensen OM. Soft-tissue sarcoma of the thigh: surgical margin influences local recurrence but not survival in 152 patients. Acta Orthop Scand 2001;72(1):72-7.
  • 23.R o s e n b e rg SA, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982;196(3):305-15.
  • 24.Brennan MF, Hilaris B, Shiu MH, Lane J, Magill G, Friedrich C, et al. Local recurrence in adult soft-tissue sarcoma. A randomized trial of brachytherapy. Arch Surg 1987;122(11):1289-93.
  • 25.Collin C, Godbold J, Hajdu S, Brennan M. Localized extremity soft tissue sarcoma: an analysis of factors affecting survival. J Clin Oncol 1987;5(4):601-12.
  • 26.Rantakokko V, Ekfors TO. Sarcomas of the soft tissues in the extremities and limb girdles. Analysis of 240 cases diagnosed in Finland in 1960-1969. Acta Chir Scand 1979;145(6):384-94.
  • 27. Coindre JM, Terrier P, Bui NB, Bonichon F, Collin F, Le Doussal V, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 1996;14(3):869-77.
  • 28.[No authors listed] Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Metaanalysis Collaboration. Lancet 1997;350(9092):1647- 54.
  • 29. Gherlinzoni F, Bacci G, Picci P, Capanna R, Calderoni P, Lorenzi EG, et al. A randomized trial for the treatment of high-grade soft-tissue sarcomas of the extremities: preliminary observations. J Clin Oncol 1986;4(4):552-8.
  • 30. Frustaci S, Gherlinzoni F, De Paoli A, et al. Maintainance of efficacy of adjuvant chemotherapy in soft tissue sarcoma of the extremities. Update of a randomized trial. Proc Am Soc Clin Oncol 1999;18:A2108.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Ayşe Nur Demiral Bu kişi benim

Mehmet Şen Bu kişi benim

Oğuz Çetinayak Bu kişi benim

Evrim Bayman Bu kişi benim

Hasan Havitçioğlu Bu kişi benim

Metin Manisalı Bu kişi benim

Sermin Özkal Bu kişi benim

İlhan Öztop Bu kişi benim

Fadime Akman Bu kişi benim

Münir Kınay Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2006
Yayımlandığı Sayı Yıl 2006 Cilt: 21 Sayı: 3

Kaynak Göster

APA Demiral, A. N., Şen, M., Çetinayak, O., Bayman, E., vd. (2006). Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler. Türk Onkoloji Dergisi, 21(3), 119-124.
AMA Demiral AN, Şen M, Çetinayak O, Bayman E, Havitçioğlu H, Manisalı M, Özkal S, Öztop İ, Akman F, Kınay M. Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler. Türk Onkoloji Dergisi. Nisan 2006;21(3):119-124.
Chicago Demiral, Ayşe Nur, Mehmet Şen, Oğuz Çetinayak, Evrim Bayman, Hasan Havitçioğlu, Metin Manisalı, Sermin Özkal, İlhan Öztop, Fadime Akman, ve Münir Kınay. “Ameliyat Sonrası Radyoterapi uygulanmış yumuşak Doku sarkomlarında Tedavi sonuçları Ve Prognostik faktörler”. Türk Onkoloji Dergisi 21, sy. 3 (Nisan 2006): 119-24.
EndNote Demiral AN, Şen M, Çetinayak O, Bayman E, Havitçioğlu H, Manisalı M, Özkal S, Öztop İ, Akman F, Kınay M (01 Nisan 2006) Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler. Türk Onkoloji Dergisi 21 3 119–124.
IEEE A. N. Demiral, “Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler”, Türk Onkoloji Dergisi, c. 21, sy. 3, ss. 119–124, 2006.
ISNAD Demiral, Ayşe Nur vd. “Ameliyat Sonrası Radyoterapi uygulanmış yumuşak Doku sarkomlarında Tedavi sonuçları Ve Prognostik faktörler”. Türk Onkoloji Dergisi 21/3 (Nisan 2006), 119-124.
JAMA Demiral AN, Şen M, Çetinayak O, Bayman E, Havitçioğlu H, Manisalı M, Özkal S, Öztop İ, Akman F, Kınay M. Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler. Türk Onkoloji Dergisi. 2006;21:119–124.
MLA Demiral, Ayşe Nur vd. “Ameliyat Sonrası Radyoterapi uygulanmış yumuşak Doku sarkomlarında Tedavi sonuçları Ve Prognostik faktörler”. Türk Onkoloji Dergisi, c. 21, sy. 3, 2006, ss. 119-24.
Vancouver Demiral AN, Şen M, Çetinayak O, Bayman E, Havitçioğlu H, Manisalı M, Özkal S, Öztop İ, Akman F, Kınay M. Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler. Türk Onkoloji Dergisi. 2006;21(3):119-24.