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| 中国尤文肉瘤肺转移多学科诊疗现状调查 |
| A survey on the current status of multidisciplinary treatment of Ewing sarcoma with lung metastases in China |
| 投稿时间：2025-11-29 修订日期：2026-01-18 |
| DOI： |
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| 中文关键词: 尤文肉瘤 肺转移 实践模式 多学科诊疗 |
| 英文关键词:Ewing sarcoma Pulmonary metastasis Practice model Multidisciplinary treatment |
| 基金项目: |
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| 中文摘要: |
| 目的 调查尤文肉瘤肺转移的多学科诊疗现状,系统了解我国尤文肉瘤肺转移的诊疗模式,为今后诊疗规范制定及临床研究方向提供循证依据。方法 2025年设计并在全国尤文肉瘤诊疗中心发放调查问卷,调查对象为参与尤文肉瘤诊疗的临床医生,调查内容为尤文肉瘤肺转移的诊断方法、治疗手段及预后情况。对调查结果进行统计描述。结果 本研究共收集有效问卷232份,包括放疗科(55.2%)、骨科或骨肿瘤科(20.7%)、肿瘤内科(13.4%),胸外科(8.2%)及其他科室(2.6%)。53.9%支持肿瘤内科主导全程治疗,84.1%推荐采用全身治疗联合局部治疗的综合策略。放疗医生中,61.8%推荐仅行病变部位的局部治疗,65.8%倾向采用立体定向放疗作为局部治疗手段。全肺放疗剂量选择呈现年龄相关性差异：≤6岁12Gy,1.5Gy/次；6~14岁15Gy,1.5Gy/次；14~17岁18Gy,1.5Gy/次；≥18岁20Gy,1.5Gy/次。71.7%的放疗科医生不推荐对局限性患者实施预防性全肺照射。外科医生在面对可切除及不可切除的单发或多发病灶时手术指征存在较大差异,但97.1%支持术后化疗,其中63.2%建议术后2~4周启动。肿瘤内科方面,66.2%倾向采用1次/2周的VDC(长春新碱+多柔比星+环磷酰胺)方案或/IE(异环磷酰胺+依托泊苷)方案化疗。生存获益标准不一,以无瘤生存时间＞6个月(45.3%)或＞ 12个月(29.3%)为主。影像诊断方面,66.2%推荐1.0~1.5mm薄层CT,53.9%建议2~3个月复查,98.3%强调发现可疑肺转移后需进行全身评估。结论 尤文肉瘤肺转移由肿瘤内科主导,采用全身联合局部治疗已形成共识。在全身及局部治疗手段方面达成了部分共识,但仍存在争议。该调查为今后研究方向提供了参考依据。 |
| 英文摘要: |
| Objective To investigate the current multidisciplinary management landscape and systematically evaluate the diagnostic and therapeutic paradigms for pulmonary metastases in Ewing sarcoma in China, thereby establishing an evidence-based foundation for future clinical guideline formulation and research prioritization. Methods In 2025, a questionnaire was designed and distributed nationally across specialized Ewing sarcoma treatment centers. The survey targeted clinicians involved in the management of Ewing sarcoma, with a focus on practices pertaining to the diagnosis, treatment, and prognostic assessment of pulmonary metastases. A statistical description of the survey results was presented. Results A total of 232 valid questionnaires were collected in this study, with responses from radiation oncology (55.2%), orthopedics or bone oncology (20.7%), medical oncology (13.4%), thoracic surgery (8.2%), and other departments (2.6%). 53.9% supported medical oncology leading comprehensive treatment throughout the course, while 84.1% recommended a combined strategy of systemic and local therapies. Among radiation oncologists, 61.9% recommended local treatment targeting only metastatic lesions, and 65.8% preferred SBRT as the local treatment modality. Dose selection for whole-lung radiotherapy showed age-related variations: ≤6 years: 12 Gy,1.5 Gy/f; 6–14 years: 15 Gy,1.5 Gy/f; 14–17 years: 18 Gy,1.5 Gy/f; ≥18 years: 20 Gy,1.5 Gy/f. 71.7% of radiation oncologists did not recommend prophylactic whole-lung irradiation for localized patients. Surgeons showed significant differences in operative indications for both resectable and unresectable solitary or multiple lesions. However 97.1% supported postoperative chemotherapy, and 63.2% recommended initiation 2–4 weeks post-surgery. In medical oncology, 66.2% favored a biweekly VDC(Vincristine+Doxorubicin+Cyclophosphamide)/IE (Ifosfamide+Etoposide) regimen. Survival benefit criteria varied, primarily defined as DFS > 6 months (45.3%) or > 12 months (29.3%). For imaging diagnostics, 66.2% recommended 1.0-1.5mm thin-slice CT, 53.9% advised follow-up every 2-3 months, and 98.3% emphasized the necessity of systemic evaluation upon detecting suspected pulmonary metastases. Conclusions There is a consensus that the management of pulmonary metastases from Ewing sarcoma should be led by medical oncology and on the use of systemic combined with local treatment. While partial agreement has been reached on systemic and local treatment modalities, considerable controversies remain. This survey provides valuable references for guiding future research directions. |
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