巨大骶骨骨巨细胞瘤患者MDT诊治报道

本文介绍1例巨大骶骨骨巨细胞瘤患者的多学科诊治过程.患者男性,24岁,因大便困难4个月,加重伴小便困难1周收治入院.骨盆影像学检查提示骶3以下椎体椎前巨大囊实性肿块,大小约16.1 cm×11.5 cm×15.4 cm,行病灶CT引导下穿刺活检病理报告示骶骨巨细胞瘤.临床分期为CampanacciⅢ期,初诊时骶骨肿瘤巨大,无法通过一期手术进行切除.经过多学科讨论后患者接受血管外科多次骶骨肿瘤血管栓塞术,在全麻下行腹主动脉球囊阻断下前后联合入路骶骨肿瘤切除内固定术,最终实现前后路的肿瘤切除.1年后开始行局部放疗,方案为设骶骨瘤区按D95包计划靶区(planning target volume,PTV)6 MV-X线DT45 Gy/ 24 F适形放疗.放疗24次.随访至术后26个月,患者KPS评分从术前的60分提高至90分,大小便功能基本正常,双下肢活动正常,日常生活基本满意.骨肿瘤(尤其是巨大的骶骨肿瘤)的多学科诊治具有重要意义,多学科诊治团队需常态化和专业化以实现患者的最大获益.

Huge sacral bone giant cell tumor managed with multidisciplinary team approach

The multidisciplinary team(MDT) management of a patient with unresectable huge sacral bone giant cell tumor is reviewed here.The patient is a 24 years old male,who was admitted to hospital due to "constipation for 4 months,exacerbated for 1 week,accompanied with urination difficulty".Pelvic imaging examination showed a huge cystic-solid anterior vertebral mass below S3,with a size of about 16.1 cm × 11.5 cm × 15.4 cm.CT-guided biopsy of the mass reported sacral giant cell tumor.The clinical stage was Campanacci Ⅲ.Since the tumor was too large to resect,the patient received a series of vascular embolization by vascular surgery after MDT discussion.The patient received sacral tumor resection and internal fixation through anterior and posterior combined approach,after abdominal aortic balloon occlusion under the general anesthesia condition.The tumor was removed completely.One year after the resection,the patient received local radiotherapy for the sacral tumor area by D95 package planning target volume (PTV) 6 MV-X line (DT 45 Gy/24 F) conformal radiotherapy for 24 cycles.The patient was followed up for 26 months after the resection.His KPS score was increased from 60 points before the operation to 90 points,with normal urination function and bilateral lower limb activity,as well as significantly improved life quality.The diagnosis and treatment process of this case showed the significance of MDT for bone tumors,especially huge sacral tumors.In order to achieve the greatest benefit of patients,it is necessary to promote MDT in all related clinical practice and to include experts in more specialties in MDT.