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目的探讨同步推量调强放射治疗(SIB-IMRT)技术制作肢体软组织肉瘤(soft tissue sareoma,STS)外科边界的临床疗效。方法应用SIB-IMRT技术对41例局部晚期肢体STS患者进行术前放疗。处方剂量:计划靶区(PTV)DT 42.0~45.0 Gy(15 f,3周),全程同步推量外科边界靶区(GTVs)DT 45.0~52.5 Gy(15 f,3周),5~7野;放疗结束后3~6周手术。测量SIB-IMRT前、后肢体周径及肿瘤大小,计算2年无复发生存率。结果 SIB-IMRT前、后患肢肢体周径分别为(53.17±17.81)cm和(50.62±18.14)cm,周径平均缩小(2.42±1.75)cm,差异有统计学意(P<0.05);SIB-IMRT后病灶缩小33例,反应率为80.49%(33/41),完全缓解(CR)0例;部分缓解(PR)18例,病灶稳定(SD)23例;随访7~55个月,伤口并发症发生率2.4%,2年无复发生存率为87.80%。4例肺转移,5例复发,其中肺转移合并复发2例。结论 SIB-IMRT制作局部晚期的肢体STS外科边界近期疗效显著,患者耐受性较好。
Objective To investigate the clinical efficacy of SIB-IMRT in the surgical border of soft tissue sareoma (STS). Methods SIB-IMRT technique was used to preoperatively treat 41 STS patients with locally advanced limbs. The prescription dose was 42.0-45.0 Gy (15 f, 3 weeks) for DTT and 45.0-52.5 Gy (15 f, 3 weeks) for DTT. 3 to 6 weeks after the end of radiotherapy surgery. The SIB-IMRT before and after limb circumference and tumor size were measured, and the 2-year recurrence-free survival rate was calculated. Results The limb circumference of the limbs before and after SIB - IMRT were (53.17 ± 17.81) cm and (50.62 ± 18.14) cm, respectively, with an average decrease of 2.42 ± 1.75 cm in circumference. The difference was statistically significant (P <0.05). After SIB-IMRT, the number of lesions was reduced in 33 cases, the response rate was 80.49% (33/41), complete remission (CR) in 0 cases; partial remission (PR) in 18 cases and stable lesions (SD) in 23 cases; , The incidence of wound complications 2.4%, 2-year recurrence-free survival rate was 87.80%. 4 cases of lung metastases, 5 cases of recurrence, of which 2 cases of pulmonary metastasis combined with recurrence. Conclusion The SIB-IMRT has the short-term curative effect in the treatment of locally advanced limb STS surgical border and the patients are well tolerated.