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目的探讨术前肢体隔离热灌注化疗术辅助治疗局部晚期肢体软组织肉瘤(soft tissue sarcoma,STS)的疗效。方法对2002年1月至2013年6月,我科收治的12例II B期的肢体STS患者行肢体隔离热灌注化疗术。化疗后14~21天行原发病灶切除术,并行病理学检查。术后11例行6周期表柔比星+异环磷酰胺(epirubicin+ifosfamide,AI)方案的辅助化疗,1例行局部放射治疗。观察并记录肢体隔离热灌注化疗后肢体疼痛、肿胀程度、原发肿瘤的变化情况;术后随访观察术后疗效、局部复发、转移、并发症及化疗毒性反应等情况。肿瘤坏死情况评价肢体隔离热灌注化疗破坏肿瘤的情况;生化检查观察治疗后患者肝肾功能的变化;毒性反应评价采用Wieberdink分级标准。结果本组12例肢体隔离热灌注化疗后2天均出现患肢肿胀、皮温升高,化疗后7~10天达到高峰,化疗后10天肿胀逐渐消退、皮温逐渐下降,化疗后2周原发病灶表现为不同程度的肿瘤缩小、皮肤移动性增大、患肢周径缩小。化疗后3天,患者转氨酶有不同程度的升高,但均未超过正常值上限的4倍,未见肾功能异常变化。肿瘤坏死率≤60%者2例(16.66%),~90%者5例(41.67%),~100%者5例(41.67%)。12例均获得随访,平均随访(27.25±37.71)个月。1例达完全缓解(complete response,CR),5例达部分缓解(partial response,PR),总缓解[overall response,OR(CR+PR)]率为50%。5例转移,2例局部复发并截肢,总局部复发率(local recurrence,LR)16.66%,总保肢率(limb salvage,LS)83.34%。1例跟腱挛缩者行跟腱延长术,恢复良好。1例肌间静脉血栓,给予溶栓治疗后治愈。Wieberdink毒性反应分级为I、II、III级,未见IV、V级毒性反应发生。结论术前肢体隔离热灌注化疗术辅助治疗肢体STS疗效满意,能明显杀灭肿瘤组织、降低术后局部复发率、改善患者的预后、副反应较小、安全性较高,对局部晚期软组织肿瘤的保肢具有重要作用。
Objective To investigate the effect of preoperative limb isolation and thermol perfusion chemotherapy in the treatment of locally advanced soft tissue sarcoma (STS). Methods From January 2002 to June 2013, 12 patients with stage II B limb STS admitted to our department underwent limb isolation and hot perfusion chemotherapy. 14 to 21 days after chemotherapy primary tumor resection, parallel pathological examination. Eleven patients underwent adjuvant chemotherapy with 6 cycles of epirubicin + ifosfamide (AI) after surgery, and 1 patient underwent local radiotherapy. The limb pain, degree of swelling and the changes of the primary tumor were observed and recorded after the limbs were isolated by hot perfusion chemotherapy. The postoperative curative effect, local recurrence, metastasis, complications and chemotherapy toxicity were observed. Tumor necrosis was evaluated by limbal isolation and thermal perfusion chemotherapy to destroy the tumor. Biochemical tests were performed to observe the changes of liver and kidney function after treatment. Toxicity evaluation was based on Wieberdink classification. Results In the 12 cases of limbs isolated by hot perfusion, swelling of the limbs occurred on the 2nd day after the chemotherapy. The skin temperature increased and peaked 7 days to 10 days after chemotherapy. The swelling gradually subsided on the 10th day after chemotherapy and the skin temperature gradually decreased. Lesions showed varying degrees of tumor shrinkage, increased skin mobility, reduced limb circumference. Three days after chemotherapy, patients with varying degrees of elevated transaminases, but no more than 4 times the upper limit of normal, no changes in renal dysfunction. The tumor necrosis rate was 60% in 2 cases (16.66%), ~ 90% in 5 cases (41.67%) and ~ 100% in 5 cases (41.67%). All 12 patients were followed up for an average of (27.25 ± 37.71) months. One patient had complete response (CR), five patients achieved partial response (PR) and the overall response (OR (CR + PR)] was 50%. Five cases had metastases, two cases had local recurrence and amputation, the local recurrence (LR) was 16.66% and the limb salvage rate (LS) was 83.34%. A case of Achilles tendon contracture Achilles tendon extension surgery, recovery is good. One case of myocutaneous thrombosis, given thrombolytic therapy after cure. Wieberdink toxicity classification for the I, II, III level, no IV, V grade toxicity occurred. Conclusions Preoperative limb isolation and thermol perfusion chemotherapy is an effective method for adjuvant treatment of limb STS, which can obviously kill the tumor tissue, reduce the local recurrence rate and improve the prognosis of the patients with less side effects and higher safety. It is helpful for the treatment of locally advanced soft tissue tumors The limb salvage has an important role.