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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。
Objective To investigate the clinical effect of preoperative radiotherapy in limb salvage surgery of soft tissue sarcoma. Methods The group of 17 males and 13 females; first diagnosis in 6 cases, 24 cases of recurrence; the oldest 89 years old, the youngest 11 years old, average 44.5 years old. Preoperative diagnosis by pathological examination after linear accelerator exposure, DT50Gy / 25 times / 35 days, 2-4 weeks after the end of radiotherapy to accept surgery. Results Follow-up time: 12-106 months postoperatively, median follow-up time: 48.3 months. The tumor reached CR (complete remission) in 2 cases and PR (partial remission) in 25 cases after preoperative radiotherapy. There was no change in 2 cases and 1 case continued to increase. Six patients died of lung metastasis after operation (no local recurrence), accounting for 20% (6/30). Two of them died of pulmonary metastasis during the treatment, three had pulmonary metastasis within one year after operation, and one had 5 years after operation Lung metastases. Two cases were locally recurred 15 months and 73 months postoperatively. The former had no recurrence and metastasis after the second extensive resection of the tumor. The latter was complicated by pathological fractures and amputation. 28 cases had no local recurrence and distant metastasis, and the local control rate was 93.3% (28/30). Delayed wound healing occurred in 8 cases, accounting for 28.7% (8/30). Conclusion Preoperative radiotherapy can reduce the surgical staging of soft tissue sarcoma, reduce the surgical resection boundary, maximize the retention of limb function, reduce the local recurrence rate and reduce the risk of limb salvage.