快中子放射治疗软组织肉瘤55例

[目的]观察快中子加光子混合射线放射治疗软组织肉瘤的临床疗效。[方法]19例软组织肉瘤患者接受快中子及光子根治性放射治疗（根治放疗组），36例为术后放疗（术后放疔组）。光子照射剂量为40～50Gy，快中子照射剂量为8～12Gv。[结果]放疗结束后根治性放疗组3年、5年、8年生存率分别为47．4％，36．8％及26．3％；术后放疗组分别为86．1％、69．6％及27．3％。放疗后所有患者均未出现严重并发症。[结论]快中子术后放疗是治疗软组织肉瘤的有效手段。     

癌巢内浸润淋巴细胞对直肠癌术前放疗的局部疗效影响

[目的]探讨癌巢内肿瘤浸润淋巴细胞(TIL)对直肠癌术前放疗近期局部疗效的影响.[方法]直肠癌单纯术前放疗病人107例,术前放疗30Gy/10f/12d,2周后手术.分析TIL与放疗疗效的关系.[结果]随访107例直肠癌术前单纯放疗病人21(2～86)个月,放疗后病理完全缓解14例(13.1%).单因素分析发现放疗后TIL、放疗后病理降级、放疗后纤维化与局部疗效相关(P＜0.01).Logistic多元回归分析发现放疗后淋巴细胞浸润是局部控制的显著因素.[结论]直肠癌放疗后癌巢内有肿瘤浸润淋巴细胞对局部控制有利.     

53例屈窝软组织肉瘤治疗经验

目的 探讨屈窝软组织肉瘤的治疗及预后。方法 53例屈窝软组织肉瘤，52例手术，其中4例以皮瓣覆盖血管、神经及修复皮肤缺损，放疗30例，化疗33例。结果伤口并发症8例，复发19例，转移21例，死亡22例。放疗、初治患者局部控制率明显优于未放疗、转诊患者，肿瘤大小及组织学级别与预后相关。结论 放疗可以提高屈窝软组织肉瘤局部控制率，肿瘤大小及组织学级别在其预后判断上有价值，使用皮瓣可以提高屈窝软组织肉瘤保肢率，减少并发症。     

24例恶性脑胶质瘤术后三维适形放射治疗分析

[目的]探讨恶性脑胶质瘤术后三维适形放射治疗的临床疗效及不良反应.[方法]自2002年1月～9月,24例恶性脑胶质瘤术后患者,接受三维适形放射治疗,治疗剂量60Gy/30次/6周.[结果]24例患者近期有效率(CR PR)83.3%(20/24),1、2年生存率为91.6%(22/24)、79.2%(9/24).放疗后出现恶心、呕吐、头痛9例(占37.5%),发生脑水肿7例(占29.2%),经脱水治疗后好转.无放射性脑损伤发生.[结论]恶性脑胶质瘤术后患者行扩大的局部三维适形放射治疗有较高的肿瘤局部控制率和1、2年生存率,无严重不良反应.     

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。     

21例恶性脑胶质瘤术后三维适形放射治疗临床观察

[目的]探讨恶性胶质瘤术后三维适形放射治疗临床疗效及其不良反应。[方法]21例恶性胶质瘤术后患者,接受三维适形放射治疗DT60Gy/30次,6周,放疗后全部随访观察。[结果]近期有效率90.5%(19/21),1、2年生存率为90.5%(19/21)、81.0%(17/21),放疗后反应较轻,未发现严重并发症。主要死因是局部未控和肿瘤复发。[结论]恶性胶质瘤术后三维适形放射治疗有较高的肿瘤局部控制率和1、2年生存率,无严重不良反应。     

腺泡状软组织肉瘤的预后影响因素分析

目的探讨腺泡状软组织肉瘤的预后影响因素。方法回顾性分析1962年5月至2008年8月接受治疗的腺泡状软组织肉瘤患者42例,男性19例,女性23例,中位年龄27岁。肿瘤原发于四肢35例,原发于躯干或其他部位7例,原发肿瘤最大中位直径为4.2cm。就诊时局限的37例患者接受了原发肿瘤的扩大切除,其中10例还接受了术后的辅助放疗。结果患者中位随诊57个月,接受了原发肿瘤扩大切除的37例患者随诊期间局部复发4例(10.8%),远处转移20例(54.1%)。全组患者5、10、15年总生存率分别为81.7%、63.6%和31.8%;5和10年总生存率与性别、就诊时年龄(<27岁与≥27岁)、原发肿瘤部位(四肢与其他部位)明显相关,与原发肿瘤大小及术后辅助放疗的关系不明显,但原发肿瘤大小与远处转移明显相关。结论局部扩大切除为腺泡状软组织肉瘤主要治疗手段,患者就诊时年龄和原发肿瘤部位是腺泡状软组织肉瘤重要预后影响因素,原发肿瘤大小与远处转移密切相关,术后辅助放疗对生存率无明显影响。     

术中置管联合高剂量率近距离放疗治疗11例软组织肉瘤

目的：观察术中置管联合高剂量率近距离放疗软组织肉瘤的毒副作用及近期疗效.方法：对11例软组织肉瘤应用高剂量率近距离放疗进行治疗.术中广泛切除肿瘤后,在瘤床放置后装管.术后第3至5天开始高剂量近距离放疗,每次剂量为200cGy,每天2次,连续5天,待伤口愈合后,再追加外照射40～50 Gy.结果：10例患者无局部复发,1例局部复发,其中1例因远处转移而死亡.各例均无明显毒副反应.结论：高剂量率近距离放疗治疗软组织肉瘤是安全易行的,并取得较好的局部控制率.在治疗软组织肉瘤方面将有可能显示出良好的应用前景.     

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。     

Re-resection with brachytherapy for locally recurrent soft tissue sarcoma arising in a previously radiated field

PURPOSE: The use of further radiotherapy among patients with soft tissue sarcoma that recurs in a previously irradiated area is controversial. Presented is a review of our 7-year experience with brachytherapy for recurrent soft tissue sarcoma. METHODS: A retrospective review was performed of 26 patients who underwent perioperative brachytherapy between 1990 and 1997 for recurrent soft tissue sarcoma. In all cases, the sarcoma recurred within a previously irradiated field. After-loading brachytherapy catheters were placed at the time of surgical extirpation of the sarcoma within a single-plane implant by use of 1-cm intercatheter spacing. Insertion of the radioactive 192Ir wire was delayed until the fifth to seventh postoperative day to allow initial wound healing. The prescribed dose rate for the 192Ir wire ranged between 50 and 80 cGy an hour, and the dose was specified at 0.5 cm from the plane of the implant. The anatomic locations treated included lower extremity (N = 10), upper extremity (N = 7), trunk (N = 7), and head and neck (N = 2). RESULTS: Total tumor extirpation, confirmed by negative frozen section margins, was accomplished in all cases. The mean dose of external-beam irradiation received before brachytherapy was 55.6 Gy +/- 1.8 Gy (range, 30.0 to 70.3 Gy). The mean dose of radiation prescribed at the implant procedure was 47.2 Gy +/- 1.6 Gy (range, 11.0 to 50.0 Gy). A tissue transfer flap was placed over the bed of resection in 13 cases. Complications occurred in five patients including, three with wound breakdown, one with osteonecrosis, and with neuralgia. Operative intervention was required in four of the five patients with complications; each of the patients requiring operative intervention for wound-related complications had undergone primary wound closure without tissue transfer. Recurrence of disease occurred in 13 patients: nine local and four distant metastases. The median follow-up was 16 months (range, 2 to 73 months). The 5-year local recurrence-free, distant recurrence-free, disease-free, and overall survival rates after brachytherapy were 52%, 75%, 33%, and 52%, respectively. CONCLUSION: Re-irradiation of recurrent soft tissue sarcoma by brachytherapy in conjunction with resection can be performed with acceptable complication rates. Local control can be achieved for the majority of patients who would otherwise require more radical surgical procedures.     

Soft tissue sarcomas: Preoperative versus postoperative radiotherapy

External beam radiation may be given either before or after excision of a primary soft tissue sarcoma. This study was undertaken to determine whether or not the timing of radiotherapy was associated with any difference in either local control, survival, or incidence of complications. The files of 112 patients with a primary, nonmetastatic, extremity soft tissue sarcoma, treated with limb salvage surgery and irradiation were evaluated. Data regarding tumor stage, grade, site, surgical margin, dosage and timing of radiotherapy, treatment complications, disease relapse, and relapse-free survival (RFS) were analyzed. Kaplan-Meier lifetable analysis was used to determine survival estimates. There was no significant difference in the 5-year RFS between patients receiving radiotherapy (RT) preoperatively versus postoperatively; 56 ± 15% and 67 ± 12% (P = 0.12, Mantel-Cox), respectively. There was no significant difference in the overall survival between patients receiving RT preoperatively versus postoperatively; 75 ± 15% and 79 ± 11% (P = 0.94), respectively. Actuarial local control at 5 years for preoperative versus postoperative RT patients was not statistically different; 83 ± 12% versus 91 ± 8% (P = 0.41), respectively. Wound complications were more frequent in preoperative RT patients (31%) compared to postoperative RT patients (8%) (P = 0.0014, chi-square). Preoperative irradiation was not associated with any benefit in terms of relapse-free survival, overall survival or actuarial local control in this series. A higher incidence of major wound complications was found among patients treated with preoperative irradiation. We recommend that patients with a resectable extremity soft tissue sarcoma be treated with postoperative irradiation, reserving preoperative irradiation for those situations in which either the tumor is initially thought to be unresectable or the original tumor boundaries are obscured. © 1996 Wiley-Liss, Inc.     

90例软组织肉瘤术后放疗临床分析

目的回顾分析软组织肉瘤术后放射治疗的疗效。方法１９８８年５月～１９９５年５月间收治９０例软组织肉瘤（多次术后复发４０例,首次术后复发５０例）,全部用６０Ｃｏ或加深层Ｘ线外照射,常规照射４５～５０Ｇｙ／５ｗ,然后缩野再用６０Ｃｏ或改用深层Ｘ线照射,总剂量低度恶性肉瘤６０Ｇｙ／６ｗ,中度恶性６５Ｇｙ／６．５ｗ,高度恶性７０Ｇｙ／７ｗ。结果３、５年生存率分别为８３．３％（７０／９０）和６１．３％（３８／６２）。局部复发率为５．６％（５／９０）,远处转移率为１１．１％（１０／９０）。影响软组织肉瘤的预后因素包括肿瘤大小、恶性程度、临床分期、术后放疗间隔时间。结论放射治疗能大幅度降低软组织肉瘤术后局部复发率。     

手术切除联合术中放疗治疗四肢复发性软组织肉瘤的安全性及近期疗效

目的:探讨手术切除联合术中放疗治疗四肢复发性软组织肉瘤的安全性及近期疗效。方法:收集2012年1月至2018年6月于我院诊断为四肢复发性软组织肉瘤并行手术切除的患者,共93例,根据患者放疗方案分为术中放疗组（38例）和体外放疗组（55例）。采用Log-rank单因素和Cox比例风险模型分析患者局部无复发生存期和总生存期的独立危险因素,并对两组术后并发症、急慢性放射性损伤、肢体功能等指标进行对比。结果:复发性软组织肉瘤局部无复发生存时间和总体生存时间与AJCC分期（P=0.030和P=0.012）和 FNCLCC分级（P=0.024和P=0.008）有关,术中放疗组与体外放疗组局部无复发生存期和总体生存时间没有明显统计学差异（P=0.663和P=0.691）。FNCLCC分级显著影响局部无复发生存期（HR=2.461,95%CI 1.094~5.537,P=0.029）和总生存期（HR=2.731,95%CI 1.249~5.971,P=0.012）。两组术后Clavien-Dindo并发症分级（P=0.048）、急性放射性损伤（P=0.043）、慢性放射性损伤（P＜0.001）以及肢体功能评分（P＜0.001）差异均有统计学意义。结论:手术切除联合术中放疗治疗四肢复发性软组织肉瘤具有较好的近期疗效及安全性。     

Wound complications following pre-operative radiotherapy for soft tissue sarcoma.

AIMS: We analysed wound complications in 43 patients with soft tissue sarcoma who were treated with combined pre-operative radiotherapy and surgery. METHODS: All patients received the same protocol of pre-operative radiotherapy at our institution. RESULTS: Thirty-six (84%) patients developed acute skin toxicity following radiotherapy. After wide local excision, 15 patients required primary soft tissue reconstruction with vascularized muscle transfer and four patients underwent free skin flap to enable wound closure as part of their primary surgery. Nineteen patients (44%) developed post-operative wound complications including 10 (23%) patients who required an additional surgical procedure. Four (27%) patients developed flap necrosis in a group of 15 who underwent primary vascularized soft tissue transfer. All required a second vascularized muscular flap. One elderly patient, who had grade 3 acute radiation skin toxicity, had an arterial graft and total hip arthroplasty for a femoral artery aneurysm and an avascular necrosis of the hip, respectively. In our series, age (> or = 40 years) was the only impact factor influencing wound complication after surgery following radiotherapy (P=0.06). CONCLUSIONS: Site of tumour, radiation field size, surgical resection volume, grade of acute radiation toxicity, co-morbidity, and smoking were not demonstrated to have predictive value in wound complication following pre-operative radiotherapy. Although previous papers suggested that vascularized soft tissue transfer could be useful reducing wound morbidity, our results could not confirm this.     

Preoperative hypofractionated radiotherapy in the treatment of localized soft tissue sarcomas

BackgroundThe primary treatment of soft tissue sarcomas (STS) is a radical resection of the tumor with adjuvant radiotherapy. Conventional fractionation of preoperative radiotherapy is 50 Gy in fraction of 2 Gy a day. The purpose of the conducted study was to assess the efficacy and safety of hypofractionated radiotherapy in preoperative setting in STS patients.Methods272 patients participated in this prospective study conducted from 2006 till 2011. Tumors were localized on the extremities or trunk wall. Median tumor size was 8.5 cm, 42% of the patients had tumor larger than10 cm, whereas 170 patients (64.6%) had high grade (G3) tumors. 167 patients (61.4%) had primary tumors. Patients were treated with preoperative radiotherapy for five consecutive days in 5 Gy per fraction, with an immediate surgery. Median follow up is 35 months.Results79 patients died at the time of the analysis, the 3-year overall survival was 72%. Local recurrences were observed in 19.1 % of the patients. Factors that had a significant adverse impact on local recurrence were tumor size of10 cm or more and G3 grade. 114 patients (42%) had any kind of treatment toxicity, vast majority with tumors located on lower limbs. 7% (21) of the patients required surgery for treatment of the complications.ConclusionIn this non-selected group of locally advanced STS use of hypofractionated preoperative radiotherapy was associated with similar local control (81%) when compared to previously published studies. The early toxicity is tolerable, with small rate of late complications. Presented results warrant further evaluation.     

Wound complications following resection of adductor compartment tumours

Purpose Limb salvage surgery of soft tissue sarcomas is associated with both a risk of local recurrence and wound complications. Although the lower limb appears to be at greater risk of wound-related morbidity, few studies separate anatomical compartments. We believe that the adductor compartment of the thigh has a particularly high rate of complications and so performed a retrospective analysis of all soft tissue sarcomas arising in this region undergoing limb salvage.Patients Patients with intermediate and high grade adductor compartment tumours were identified from our database and the case notes were reviewed for patient, tumour, surgical and wound variables, identifying those with wound complications both before and after discharge.Results Of 49 patients who underwent limb salvage surgery, 22 (42.9%) developed complications. Twelve patients (24.5%) required further surgery prior to wound healing and 10 patients had delays in post-operative radiotherapy. There were significant differences in the rates of preceding surgery, open biopsy performed at other centres and previous radiotherapy to this region between the complicated and uncomplicated groups.Discussion The management of these difficult tumours carries a high rate of wound complications and requires careful planning prior to tissue biopsy. Open biopsies should be performed by the tumour surgeon to allow easy inclusion of this site in the definitive procedure. In previously irradiated or operated limbs, alternative strategies for wound management may need to be considered.     

A combination of intraarterial chemotherapy, preoperative and postoperative radiotherapy, and surgery as limb-saving treatment of primarily unresectable high-grade soft tissue sarcomas of the extremities

The localization and size of a high-grade soft tissue sarcoma of an extremity are generally the limiting factor in limb-saving surgery. Since 1982 nine patients with a high-grade soft tissue sarcoma of an extremity, which usually requires amputation, have been treated by intraarterial chemotherapy, preoperative and postoperative radiotherapy, and surgery. The limb was saved in eight patients (89%). During a median follow-up of 24 months (mean follow-up 32 months, range 12 to 64 months) one local recurrence and four distant metastases were diagnosed. Three patients developed complications due to the intraarterial chemotherapy, a motor and sensory neuropathy of the sciatic nerve was diagnosed in one patient, and two patients developed a flexion contracture of the knee. The results obtained in this small series show that the combination of intraarterial doxorubicin, preoperative and postoperative radiotherapy, and surgery is feasible in limb-saving treatment of primarily "unresectable" high-grade soft tissue sarcomas of the extremities without increasing the risk of a local recurrence.     

Wound healing morbidity in STS patients treated with preoperative radiotherapy in relation to in vitro skin fibroblast radiosensitivity, proliferative capacity and TGF-beta activity.

BACKGROUND AND PURPOSE: In a recent study, we demonstrated that the ability of dermal fibroblasts, obtained from soft tissue sarcoma (STS) patients, to undergo initial division in vitro following radiation exposure correlated with the development of wound healing morbidity in the patients following their treatment with preoperative radiotherapy. Transforming growth factor beta (TGF-beta) is thought to play an important role in fibroblast proliferation and radiosensitivity both of which may impact on wound healing. Thus, in this study we examined the interrelationship between TGF-beta activity, radiosensitivity and proliferation of cultured fibroblasts and the wound healing response of STS patients after preoperative radiotherapy to provide a validation cohort for our previous study and to investigate mechanisms. PATIENTS AND METHODS: Skin fibroblasts were established from skin biopsies of 46 STS patients. The treatment group consisted of 28 patients who received preoperative radiotherapy. Eighteen patients constituted a control group who were either irradiated postoperatively or did not receive radiation treatment. Fibroblast cultures were subjected to the colony forming and cytokinesis-blocked binucleation assays (low dose rate: approximately 0.02 Gy/min) and TGF-beta assays (high dose-rate: approximately 1.06 Gy/min) following gamma-irradiation. Fibroblast radiosensitivity and initial proliferative ability were represented by the surviving fraction at 2.4 Gy (SF(2.4)) and binucleation index (BNI), respectively. Active and total TGF-beta levels in fibroblast cultures were determined using a biological assay. Wound healing complication (WHC), defined as the requirement for further surgery or prolonged deep wound packing, was the clinical endpoint examined. RESULTS: Of the 28 patients treated with preoperative radiotherapy, 8 (29%) had wound healing difficulties. Fibroblasts from patients who developed WHC showed a trend to retain a significantly higher initial proliferative ability after irradiation compared with those from individuals in the treatment group with normal wound healing, consistent with the results of our previous study. No link was observed between fibroblast radiosensitivity and WHC. Neither active nor total TGF-beta levels in cultures were significantly affected by irradiation. Fibroblast proliferation in unirradiated and irradiated cultures, as well as radiosensitivity, was not influenced by TGF-beta content. TGF-beta expression in fibroblast cultures did not reflect wound healing morbidity. CONCLUSIONS: These data are consistent with our previous study and combined the results suggest that in vitro fibroblast proliferation after irradiation may be a useful predictor of wound healing morbidity in STS patients treated with preoperative radiotherapy. TGF-beta levels in culture do not predict WHC, suggesting that the role of TGF-beta in wound healing is likely controlled by other in vivo factors.     

骨盆区域复发骨与软组织肿瘤手术加术中放疗的围手术期安全性评价北大核心CSCD

目的探讨骨盆复发骨与软组织肿瘤手术联合术中放疗(intra-operative radiation therapy,IORT)的安全性。方法随机选取在郑州大学附属肿瘤医院住院的骨盆复发骨与软组织肿瘤患者40例,将其分为两组:手术联合IORT组(n=20),行骨盆肿瘤手术联合IORT;术前放疗联合手术组(n=20),术前常规放疗后行肿瘤扩大切除手术。比较两组患者术中、术后指标及并发症发生情况等。结果手术联合IORT组20例患者中发生术后直肠、膀胱并发症1例,明显少于术前放疗联合手术组(6例),差异有统计学意义(P<0.05);手术联合IORT组患者术中出血量为(946.33±66.27)ml,略多于术前放疗联合手术组患者(750.66±56.19)ml;但手术联合IORT组患者住院时间和切口拆线时间分别为(8.27±0.64)d和(13.53±0.65)d,明显短于对照组(10.67±1.15)d和(16.17±0.76)d,差异均具有统计学意义(P<0.05)。手术时间、术后血液白细胞计数、术后创腔引流量、切口液化及口感染,两组比较,差异无统计学意义(P>0.05)。结论骨盆复发性骨与软组织肿瘤手术联合IORT具有术后易恢复、安全性好、常规放疗相关并发症少等优点,在临床应用中是安全可行的。