野中野照射加大剂量顺铂水化防治软组织肉瘤术后复发的临床研究

目的评价野中野照射加大剂量顺铂（HD-PDD）水化技术在软组织肉瘤综合治疗中的地位及其疗效。方法127例软组织肉瘤术后患者随机分为研究组67例（野中野照射加HD-PDD水化）和对照组60例（常规照射、化疗）。研究组放射治疗：大野40～50 Gy,4～5周,小野20～30 Gy,3～4周,每天2野照射,间隔6 h;化疗：PDD 80～100 mg/m^2,每3周1次,共2～3次。对照组放射治疗：40～50 Gy,4～5周,后缩野加量20～30 Gy,2～3周。结果研究组和对照组1,3,5年生存率分别为95.5%和78.3%（P〈0.05）,82.1%和60.0%（P〈0.05）,70.2%和53.3%（P〉0.05）。研究组和对照组1,3,5年局部复发率分别为4.5%和10.0%（P〉0.05）,9.0%和31.7%（P〈0.05）,25.5%和41.7%（P〉0.05）。结论野中野照射加HD-PDD水化技术可在短时间内使肿瘤区接受较高剂量及获得放射治疗增敏,且明显提高了生存率,降低了局部复发率,作为术后综合治疗技术在软组织肉瘤治疗中具有重要价值。

Field-in-field radiotherapy and high-dose cisplatin-hydration chemotherapy in the prevention of postoperative recurrence of soft tissue sarcomas

Objective To observe the efficacy of field-in-field radiotherapy combined with （high dose cisplatin, HD-PDD） chemotherapy in treating patients with soft tissue sarcomas. Methods From January 1995 to October 2001, 127 patients with soft tissue sarcomas after operation were randomized into two groups： study group （67 cases） received field-in-field radiotherapy and HD-PDD chemotherapy and control group （60 cases） received routine radiotherapy only. Radiotherapy of the study group： large field 40-50 Gy, 4-5 weeks, small field 20-30 Gy, 3-4 weeks, 2 field/day, with an interval of 6 hours between fractions. Chemotherapy： cisplatin 80-100 mg/m^2, 1 dose/3 weeks, 2-3 doses/case. Radiotherapy of the control group： 40-50 Gy, 4-5 weeks, reduced field boost 20-30 Gy, 2-3 weeks. Results The 1-, 3-and 5-years survival rates for the study group and control group were 95. 5% and 78. 3% （ P 〈 0. 05 ）, 82. 1% and 60. 0% （P 〈0. 05） ,70. 2% and 53.3% （P 〉0.05） respectively. The 1-, 3- and 5-years local recurrence rates were 4. 5% and 10.0% （P 〉0.05） ,9. 0% and 31.7% （P 〈0. 05） ,25. 5% and 41.7% （P 〉0. 05） respectively. Conclusions The field-in field radiotherapy and HD-PDD chemotherapy can increase the survival rate which may play an important role in the freatment of postoperative soft tissue sarcomas.