软组织肉瘤手术加术中放疗的临床研究

目的：探讨软组织肉瘤术中放疗的意义。方法：对39例软组织肉瘤患者行根治或姑息性手术，术中放疗在术中放疗手术室进行，术中根据肿瘤大小，选择不同术中放疗限光筒及6～12MeV电子线1次照射15～25Gy，姑息手术者剂量加大至36Gy。术后辅以外照射治疗，常规设野，5／周，2Gy／次，总量40～50Gy。初发病灶10例，术后复发29例。结果：39例患者随访12～64个月，3、5年局控率分别为71．8％和64．1％。3年生存率为82．0％。结论：术中放疗具有较高的局控率，比之其他治疗具有许多优点，将获得较高的生存率。     

软组织肉瘤术后复发原因探讨(附33例报告)

目的　探讨软组织肉瘤的术后复发原因及治疗方法。方法　 33例软组织肉瘤术后复发病人 ,结合临床资料 ,分析其手术方式、术后辅助治疗和软组织肉瘤复发的关系。结果　复发病灶大小 :1 5cm× 1.5cm× 1.0cm～ 2 0cm× 2 0cm× 18cm ;复发时间 :术后 10天～ 4年 ,平均 8 2月。术后 3月内复发者 10例 (30 3% )。第 1次术后行放疗和 (或 )化疗者 13例 (39 4% ) ,未行放疗和 (或 )化疗者 2 0例 (6 0 6 % )。再次手术者广泛切除术 2 7例 ,姑息性切除 1例 ,不能手术者 5例。结论　软组织肉瘤术后复发的主要原因为手术切除不彻底 ,术后不积极应用放疗和化疗 ,术后不进行病理检查或病理诊断错误。对术后复发病人应积极进行再次手术治疗。     

快中子加光子术后放疗软组织肉瘤

目的：回顾分析快中子加光子术后放疗软组织肉瘤的疗效。方法：1991年12月至1997年6月用快中子及光子术后放疗软组织肉瘤36例。结果：3、5年生存率分别为86.1%（31/36）及69.6%（16/23）。3、5年局控率分别为97.2%(35/36)及95.6%(22/23)。远处转移率为13.9%（5/36）。结论：快中子术后放疗是治疗软组织肉瘤的有效方法。     

综合疗法防治软组织肉瘤术后复发的临床研究(野中野照射加大剂量顺铂水化技术的临床应用)

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　63 例软组织肉瘤术后患者随机分为研究组32 例( 野中野照射加HDPDD水化) ,对照组31 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 小时;化疗:PDD80～100 mg/m2 ,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　1,2 ,3 年生存率分别为93.8 % 和77.4% ,84 .4% 和64 .5% ,81.3 % 和58.1 %( P<0 .05)。研究组局部复发率和远地转移率降低,但与对照组比较差异无显著意义( 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,降低了局部复发率和远地转移率,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     

重组人p53基因联合放疗、热疗治疗晚期软组织肉瘤的临床观察

目的:评价重组人p53基因腺病毒注射液(rAdp53)结合放疗、热疗治疗软组织肉瘤的疗效及安全性。方法:自2001年11月～2005年7月,采用rAdp53制剂“今又生”结合放疗、热疗共治疗晚期软组织肉瘤12例。“今又生”用法:每周1次,每次1×1012VP(病毒颗粒),平均8±2次。放疗方案:每次2Gy,每周5次,肿瘤量为16-70Gy/8-35次/2-8周,平均56.3±6.3Gy。热疗方法:采用浅部或深部热疗,每周1-2次,平均9±3次。观察肿瘤变化、患者的自觉症状改变与不良反应,并以CT评价疗效。结果:CR8.3%(1/12),PR33.3%(4/12),SD58.4%(7/12)。7例SD病人中亦达到止痛、减轻局部症状的目的。1年生存率为58.3%(7/12),2年生存率为16.7%(2/12),SD>6个月4例,实际临床获益率(CR PR SD>6月)为75%(9/12)。12例患者都接受多次“今又生”瘤内注射,除了出现一时性发热外,未发现其它不良反应。结论:软组织肉瘤瘤内注射rAdp53结合放疗、热疗是安全而有效的。rAdp53是一种很有潜力的治疗恶性软组织肿瘤的基因治疗药物。     

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。     

24例Kaposi's肉瘤放疗的远期疗效分析

目的 探讨Kaposi's肉瘤放疗的疗效.方法 采用60Coγ线或直线加速器X线和电子线混合线常规分割照射,180-200 cGy/次,5次/周,总剂量30～62 Gy.单纯放疗2例,22例放疗前后用CHOP方案化疗1～3个周期同时应用生物治疗(LAK、干扰素、免疫核糖核酸和白细胞介素Ⅱ等).结果 24例患者总5、10年生存率分别为79%、54%.放疗剂量30～36 Gy者5例,5、10年生存率分别为60%、20%;放疗剂量40～48 Gy者8例,5、10年生存率分别为75%、50%;放疗剂量50～62 Gy者11例,5、10年生存率分别为91%、73%.三者5、10年生存率无差异可能与分层分析后例数少有关.结论 放疗对Kaposi's肉瘤有较好的远期疗效.     

隆突性皮肤纤维肉瘤的术后放疗

目的研究放疗在隆突性皮肤纤维肉瘤（DFSP）中的价值。方法回顾性分析1993年1月-2002年12月收治经组织病理学确诊的43例DFSP患者。且手术次数至少1次以上，术后放疗剂量多数为50～60Gy。结果43例患者手术后共复发91次，第一次手术后复发时间多在0．5～7年（39／43），第二次手术后复发时间多在1～24个月（21／39），均行手术＋放疗。中位随访时间37个月，40例（93．0％）达到局部控制，3例（7．0％）局部复发。结论术后放疗能有效降低DFSP的复发率，放疗剂量50-606y较为合适。     

放疗应用于骨与软组织肉瘤及传统与案例交互教学法的应用研究

目的 探讨不同模式放疗应用于骨与软组织肉瘤患者的疗效及安全性并交流推广传统与案例交互教学法(LBL-CBL)的经验。方法 收集2019年10月至2021年12月南京大学医学院附属鼓楼医院肿瘤中心接受放疗的99例骨与软组织肉瘤患者资料。3例患者行术前新辅助放疗(45～50 Gy);25例患者行术后放疗,包括22例术后辅助放疗(45～60 Gy),3例术后残留病灶放疗(45～60 Gy);37例患者行免疫放疗(6～40 Gy);33例患者行常规剂量姑息放疗(25～75 Gy);1例患者行根治剂量放疗(54 Gy)。选择其中18例患者,采用LBL-CBL,对规培医生进行基础知识、模拟定位、靶区勾画、放疗计划评估、疗效评价、患者随访等方面的教学,并采用出科考试及调查表的方法评估教学效果和满意度。结果 共81例患者进行疗效评价。3例(3/3,100%)术前新辅助放疗患者术后病理均提示肿瘤发生坏死。术后辅助放疗组平均随访时间10.5个月,3例(3/19,15.8%)疾病进展,包括1例全身转移,2例原位复发,16例(16/19,84.2%)未复发。术后残留病灶放疗组平均随访时间10.8个月,1例(1...     

四肢软组织肉瘤术前与术后放疗临床观察

[目的]探讨四肢软组织肉瘤术前与术后放疗时间的选择及并发症情况.[方法]回顾分析43例四肢软组织肉瘤病人,其中21例术前行放射治疗(25Gy/5F),22例术后行放射治疗(66Gy/33F),观察两组病人疗效及术后伤口并发症的发生率.[结果]平均随访3.5年,术前放疗者总的生存情况稍好于术后放疗者(P＜0.05);但术前放疗者发生伤口并发症8例(38%),而术后放疗者4例(18%);而且肿瘤大小和解剖位置与并发症有关.[结论]由于术前放疗比术后放疗有较高的伤口并发症发生率,四肢软组织肉瘤治疗时应该考虑放疗的时间选择,同时考虑肿瘤大小及解剖位置.     

Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma.

METHODS AND MATERIALS: Forty-five patients were consecutively treated for primary retroperitoneal soft tissue sarcoma with surgery in combination with radiation therapy in the same institution. The median follow-up time was 53 months (7-108). RESULTS: Seventeen (38%) patients had clear microscopic margins (R0 resection), 26 patients (58%) had gross complete surgical excision (R1 resection) and two patients (4%) had a macroscopic residual disease (R2 resection). External radiotherapy doses ranged from 40.8 to 59.4 Gy (mean and median: 49 Gy). Seventeen patients underwent intraoperative radiation therapy (IORT). Moreover, 11 patients received chemotherapy. The overall 1-, 2-, and 5-year survival for all 45 patients were 93, 85 and 60%, respectively. The 1-, 2-, and 5-year locoregional relapse-free rate for the whole group was 91, 70 and 40%, respectively. In univariate analysis, quality of surgery was the only variable to show a significant effect for overall survival (P=0.0386) and for local control (P=0.0059). Tumor size and tumor grade had no statistically significant effect. For the patients receiving IORT+external beam radiation therapy, no difference was observed for survival or locoregional control. The most frequent acute side effects treatment complications were radiation-induced nausea or vomiting (42%) and moderate enteritis (30%). Significant late morbidity was observed for two patients. CONCLUSIONS: This study confirms the feasibility of external postoperative radiotherapy with an acceptable level of toxicity. However, the high rate of local relapses (especially in field of radiation) does not demonstrate the usefulness of radiotherapy at the level of dose used and further preferably randomized studies should be planned.     

Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment

PURPOSE: To evaluate the clinical outcomes of patients with localized retroperitoneal soft tissue sarcoma (STS) treated with complete surgical resection and radiation. METHODS AND MATERIALS: The medical records of 83 patients were reviewed retrospectively. Sixty patients presented with primary disease and the remaining 23 had recurrence after previous surgical resection. RESULTS: With a median follow-up of 47 months, the actuarial overall disease-specific survival (DSS), distant metastasis-free survival, and local control (LC) rates were 44%, 67%, and 40%, respectively. Of the 38 patients dying of disease, local disease progression was the sole site of recurrence for 16 patients and was a component of progression for another 11 patients. Multivariate analysis indicated that histologic grade was associated with the 5-year rates of DSS (low-grade, 92%; intermediate-grade, 51%; and high-grade, 41%, p = 0.006). Multivariate analysis also indicated an inferior 5-year LC rate for patients presenting with recurrent disease, positive or uncertain resection margins, and age greater than 65 years. The data did not suggest an improved local control with higher doses of external-beam radiation (EBRT) or with the specific use of intraoperative radiotherapy (IORT). Radiation-related complications (10% at 5 years) developed in 5 patients; all had received their EBRT postoperatively. CONCLUSIONS: Although preoperative radiation therapy and aggressive surgical resection is well tolerated in patients, local disease progression continues to be a significant component of disease death. In this small cohort of patients, the use of higher doses of EBRT or IORT did not result in clinically apparent improvements in outcomes.     

Moderate dose intraoperative and external beam radiotherapy for locally recurrent rectal carcinoma.

BACKGROUND AND PURPOSE: Late adverse effects (i.e. neuropathy, chronic bowel obstruction) limit the effective dose given in intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT). Initial results of a multi-modality treatment approach using moderate dose IORT and moderate dose EBRT are presented. PATIENTS AND METHODS: Thirty-one consecutive patients with recurrent rectal carcinomas had IORT and EBRT after complete (R0, n = 14) or incomplete resection (R1, n = 9; R2, n = 8). The mean [ORT dose was 13.7 Gy (range 12-20 Gy) supplemented with an EBRT dose of 41.4 Gy. Twenty-two patients had preoperative EBRT and 22 patients had concomitant chemotherapy (5-FU, Leucovorine). RESULTS: After a median follow-up of 28 months, 16 patients had re-recurrent disease and 11 patients had died. Nine patients failed locally (four in-field, four marginal and one anastomotic re-recurrence), three combined with distant metastasis, resulting in overall and IORT infield local control rates of 71% and 87%, respectively. Distant metastases alone were found in seven patients. The 4-year overall and relapse-free survival rates were 58% and 48%, respectively. After incomplete resection the local failure rate increased (R0 21%, R1/2 35%) and the 4-year relapse-free survival rate decreased significantly (29% versus 71%) due to a markedly increased distant metastasis rate (53% versus 7%). Acute and late toxicities were not increased. CONCLUSION: The combination of moderate dose IORT and EBRT is a safe and efficacious component in a multi-modality treatment approach.     

肢体软组织肉瘤术后放疗缩小放疗野的临床观察

目的 探讨肢体软组织肉瘤术后缩小放疗野放疗的效果,重点观察局部控制率和不良反应发生情况。方法 回顾性分析2017年10月至2021年3月清华大学第一附属医院收治的49例肢体软组织肉瘤患者,所有患者术后均接受调强放疗。采用定位CT和术后MRI图像融合的方法进行靶区勾画,定义瘤床（GTV_tb）在纵轴方向外扩3 cm,横轴方向外扩1.5 cm形成临床靶区（CTV,解剖屏障可适当修回,且需包全肿瘤周围水肿区）。GTV_tb和CTV分别外扩0.5 cm形成计划靶区1（PTV1）和PTV2,放疗处方剂量：PTV1_95%为63~66 Gy,PTV2_95%为50~56 Gy,单次1.8~2.0 Gy。若术后镜下切缘阳性,瘤床区域推量至70 Gy。结果 随访7.9~45.6个月,中位随访时间32.1个月。3年无局部失败生存率、总生存率和无远处转移生存率分别为91.7%、77.6%、71.5%。单因素分析结果显示,术后镜下切缘阳性的患者更容易出现局部复发,P<0.05。2级及以上伤口并发症、关节僵硬、骨折、水肿、皮肤纤维化的发生率分别为2%、4.1%、2%、8.2%、26.5%。结论 术后放疗缩小放射野治疗肢体软组织肉瘤得到了较好的局部控制率,且晚期不良反应发生率较低。     

肢体软组织肉瘤术后放疗缩小放疗野的临床观察

目的 探讨肢体软组织肉瘤术后缩小放疗野放疗的效果,重点观察局部控制率和不良反应发生情况。方法 回顾性分析2017年10月至2021年3月清华大学第一附属医院收治的49例肢体软组织肉瘤患者,所有患者术后均接受调强放疗。采用定位CT和术后MRI图像融合的方法进行靶区勾画,定义瘤床（GTV_tb）在纵轴方向外扩3 cm,横轴方向外扩1.5 cm形成临床靶区（CTV,解剖屏障可适当修回,且需包全肿瘤周围水肿区）。GTV_tb和CTV分别外扩0.5 cm形成计划靶区1（PTV1）和PTV2,放疗处方剂量：PTV1_95%为63~66 Gy,PTV2_95%为50~56 Gy,单次1.8~2.0 Gy。若术后镜下切缘阳性,瘤床区域推量至70 Gy。结果 随访7.9~45.6个月,中位随访时间32.1个月。3年无局部失败生存率、总生存率和无远处转移生存率分别为91.7%、77.6%、71.5%。单因素分析结果显示,术后镜下切缘阳性的患者更容易出现局部复发,P<0.05。2级及以上伤口并发症、关节僵硬、骨折、水肿、皮肤纤维化的发生率分别为2%、4.1%、2%、8.2%、26.5%。结论 术后放疗缩小放射野治疗肢体软组织肉瘤得到了较好的局部控制率,且晚期不良反应发生率较低。     

Intraoperative radiation therapy for patients with recurrent rectal and sigmoid colon cancer in previously irradiated fields.

A retrospective study evaluated 15 patients with pelvic recurrence of colorectal cancer in a previously irradiated region who received intraoperative radiation therapy (IORT) as part of salvage therapy. Total prior external beam radiation therapy (EBRT) doses ranged from 45 to 79.2 Gy. Tumor resection was accomplished in 14 patients, with an exenteration performed in seven. IORT dose was 15-20 Gy. Three patients received additional EBRT as a post-operative course of 25.2 Gy in 14 fractions. Actuarial 3-year local control rate was 25%. The 3-year overall survival rate was 29%. Patients with fixed and/or bulky pelvic tumors had a local control rate of 19% at 12 months and median overall survival of 9 months. Patients with less extensive clinical presentations of anastomotic non-fixed transmural recurrence, isolated pelvic node metastasis and rectal recurrence following local excision had a local control rate of 42% at 36 months and median survival of 43 months. We conclude that clinical presentation of recurrent disease is an important prognostic factor. The value of IORT may be limited to patients with less extensive clinical presentations.     

Preoperative radiotherapy for soft tissue sarcoma: The Peter MacCallum Cancer Centre experience

AIM: Radiotherapy has been shown to improve local control in combination with limb-sparing or conservative surgery in the management of localised soft tissue sarcoma. Our centre's treatment protocol is to offer preoperative external beam radiotherapy (50.4Gy in 28 fractions) followed by surgery four to six weeks later. The aim of this study is to review the treatment outcome and toxicity of patients treated with this protocol. METHODS: Consecutive patients with localised extremity or truncal soft tissue sarcoma who presented between January 1996 and December 2000 and treated with preoperative radiotherapy followed by limb-sparing surgery were reviewed. Patients with recurrent disease or metastatic disease at diagnosis and patients below the age of 16years were excluded. Local and distant recurrence, overall survival and treatment toxicity were analyzed. RESULTS: Sixty-seven cases were identified (41 males and 26 females). The median age was 52years (range 17 to 82). The majority (79%) had tumours located in the lower limb. The most common histological diagnoses were malignant fibrous histiocytoma and liposarcoma. The median follow-up was 4.1years (range 0.6 to 6.9). There were six local recurrences, two of which were successfully salvaged. Twenty patients developed distant metastases. The estimated 5-year actuarial local recurrence free, distant recurrence free and overall survival were 93%, 68% and 73% respectively. Acute radiotherapy toxicity and wound complications were acceptable and late toxicity was uncommon. CONCLUSION: Preoperative radiotherapy followed by surgery provides effective local control in the management of soft tissue sarcoma.     

Postoperative radiotherapy in the management of adult soft tissue sarcoma of the extremities: results with two different total dose, fractionation, and overall treatment time schedules.

PURPOSE: This retrospective study was performed to evaluate two postoperative radiotherapy schedules in terms of dose, fractionation, and overall treatment time in soft tissue sarcoma (STS) of the extremities. METHODS AND MATERIALS: Between January 1984 and December 1993, 62 patients with newly diagnosed localized STS of the extremities were treated with maximal conservative surgery and postoperative radiotherapy (RT). Forty-five patients received 50 Gy with conventional fractionation plus a boost dose (5 to 20 Gy). Seventeen patients had hyperfractionated accelerated radiotherapy (HFART) up to a dose of 45 Gy in 3 weeks. RESULTS: With a median follow-up of 72 months, the 5-year local failure rate was 25%, the 5-year disease-free and overall survival rates were respectively 42% and 62%. The 3-year local relapse, disease-free, and overall survival rates were respectively 16%, 44%, and 70% in the conventional radiotherapy group, and 36%, 47%, and 82% in the HFART group (NS). No factor significantly influenced local control with a trend, however, in favor of conventional RT (p = 0.10). CONCLUSION: HFART at the dose of 45 Gy does not seem to be superior to the standard RT schedule, neither in terms of local control, survival, nor in terms of long-term side effects. However this dose could be considered too low as well as the power of comparison between the two groups to draw definitive conclusions.     

Intraoperative radiation therapy in resected pancreatic carcinoma: long-term analysis

PURPOSE: The combination of external radiotherapy (RT) plus intraoperative radiotherapy (IORT) in patients with pancreatic cancer is still debated. This study presents long-term results (minimum follow-up, 102 months) for 26 patients undergoing integrated adjuvant RT (external RT+IORT). METHODS AND MATERIALS: From 1990 to 1995, a total of 17 patients with pancreatic cancer underwent IORT (10 Gy) and postoperative external RT (50.4 Gy). Preoperative "flash" RT was included for the last 9 patients. The liver and pancreatic head received 5 Gy (two 2.5-Gy fractions) the day before surgery. In the subsequent period (1996-1998), 9 patients underwent preoperative concomitant chemoradiation (39.6 Gy) with 5-fluorouracil, IORT (10 Gy), and adjuvant chemotherapy. RESULTS: Preoperative chemoradiation was completed in all patients, whereas postoperative therapy was completed in 13 of 17 patients. All 26 patients underwent pancreatectomy (25 R0 and one R1 resections). One patient died of postoperative complications (3.8%) not related to IORT. The 9 patients undergoing concomitant chemoradiation were candidates for adjuvant chemotherapy; however, only 4 of 9 underwent adjuvant chemotherapy. At last follow-up, 4 patients (15.4%) were alive and disease free. Disease recurrence was documented in 20 patients (76.9%). Sixteen patients (61.5%) showed distant metastasis, and 5 patients (19.2%) showed local recurrence. The incidence of local recurrence in R0 patients was 4 of 25 (16.0%). The overall 5-year survival rate was 15.4%. There was significant correlation with overall survival of tumor diameter (p=0.019). CONCLUSIONS: The incidence of local recurrence in this long follow-up series (19.2%) was definitely less than that reported in other studies of adjuvant RT (approximately 50%), suggesting a positive impact on local control of integrated adjuvant RT (IORT+external RT).     

Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study.

BACKGROUND: The therapeutic gain of surgery for recurrent rectal cancer is not clear, particularly with regard to the addition of intraoperative radiotherapy (IORT). METHODS: Patients (107) with isolated pelvic recurrence of rectal cancer received preoperative external radiotherapy of 46-50 in 2 Gy fractions. At surgery 59 patients had IORT 12-18 Gy. Survival and local recurrence was analysed with regard to surgical resection stages and IORT. RESULTS: Patients (44) had R0- and 39 R1-resections, 24 R2-resections or exploratory laparotomy. IORT was given most often after R1-resections, least in R0-patients. Estimated 5-year survival was overall around 30%, around 60% in the R0-, around 25% for R1- and 0% in R2-patients. Local recurrence was around 30% in the R0- and around 65% in R1-stage patients. R0-/R1-stage patients survived statistically significantly longer than the R2-group otherwise there was no statistical significant difference between IORT and non-IORT groups in any R-stages regarding overall survival or local recurrence. CONCLUSIONS: Macroscopic removal of the recurrence improves survival. Whether R0- is better than R1-resections is not clear. The effect of IORT is not a major one. IORT need be evaluated in randomised controlled trials.