术前放疗在软组织肉瘤保肢手术中的临床应用

目的 探讨术前放疗在软组织肉瘤保肢手术中的临床效果.方法 本组男17例,女13例;首诊6例,复发24例;年龄最大89岁,最小11岁,平均44.5岁.术前经病理检查确诊后接受直线加速器外照射,DT50Gy/25次/35天,放疗结束后休息2-4周即接受手术治疗.结果 随访时间:术后12-106个月,中位随访时间:48.3个月.术前放疗后肿瘤达到CR (complete remission) 2例、PR (partial remission) 25例,2例无变化,1例继续增大.术后因肺转移死亡6例(局部均无复发),占20% (6/30),其中2例为治疗期间出现肺转移,3例术后1年内出现肺转移,1例术后5年出现肺转移.2例分别于术后15个月和73个月局部复发,其中前者经二次广泛切除肿瘤后无复发及转移,后者合并病理性骨折而行截肢.28例无局部复发及远处转移,局部控制率93.3%(28/30).8例伤口延迟愈合,占28.7% (8/30).结论 术前放疗可以降低软组织肉瘤外科分期,缩小外科切除边界,最大限度保留肢体功能,降低局部复发率,降低保肢风险.

Clinical application of preoperative radiotherapy in limb salvage surgery for soft tissue sarcoma

Objective To evaluate clinical efficacy of preoperative radiotherapy in limb salvage surgery for soft tissue sarcoma. Methods Participants included 30 patients with soft tissue sarcoma. There were 17 males and 13 females with the mean age of 44.5 years （range, 11-89 years）. Primary tumor （n=6）, recurrence （n=24）. The preoperative radiotherapy was applied after diagnosis. Preoperative DT was 50Gy in 35 days （total 25 times）. The surgery was performed 2-4 weeks after radiation. Results All patients were followed up for a medial period of 48.3 months （range, 12-106 months）. After preoperative radiotherapy, tumor complete remission （n=2）, partial remission （n=25）, with no change （n=2）, increase （n=l）. Postoperatively, there were 6 cases died due to lung metastases （no local recurrence）, accounting for 20% （6/30）. There were 2 cases found lung metastasis during treatment, 3 cases after 1 year, 1 case after 5 years. Local recurrence were found on 2 cases after surgery, 1 case after 15 months and was treated by a second- time extensive tumor resection （no recurrence and metastases）; 1 case after 73 months and was treated by amputation due to pathological fracture （maybe radiation-induced bone strength reduction）. 28 cases had no local recurrence and metastases with a local control rate of 93.3% （28/30）. 8 cases had delayed wound healing, accounting for 28.7% （8/30）. Conclusions Preoperative radiotherapy can decrease the surgical stage of soft tissue sarcoma, narrow surgical excision boundary, keep maximum limb function, reduce local recurrence and enhance limb salvage rate.