Fan Q, Ma B, Guo A
Department of Orthopedic Surgery, Second Hospital, Fourth Military Medical University, Xian.
Zhonghua Wai Ke Za Zhi. 1997 Aug;35(8):484-7.
Limb-sparing procedures have been well established for dealing with malignant bone tumors. Unfortunately, these procedures have different problems. We used an alternative operation combined with microwave-induced hyperthemia to modify the surgical methods. Thermotherapy with microwave intracorporeal irradiation was used to treat 112 patients with bone tumors. In this series, 79 had malignant tumors and 33 aggressive benigh tumors. Postoperatively, immune therapy was carried out regularly. The patients immunologic functions were monitored by assay of the subpopulation of T cells, IL-2 and sIL-2R (soluble IL-2 receptor). Follow-up varied from 3 to 50 months (mean 23 month) s. Excluding 5 patients with malignancy in the vertebrae treated for palliation, 107 were evaluated by oncological and orthopedic criteria. 10 patients had local recurrence and required amputation. The remaining 97 had excellent local control. In 12 of the 74 patients with malignancy of the extremities, lung metastasis occurred 4 months to 2 years after surgery. Pathological fracture occurred at devitalized bone in 8 patients. In 29 out of 40 tumor-free cases followed for more than 2 years, the knee joints functioned properly with almost full range of motion. Single photon emission computered tomography (SPECT) study revealed revascularization of the devitalized tumor bearing bone segment could accomplish in one year or more. The immune state was improved after thermotherapy plus immunotherapy in the majority of patients. These results indicated that the use of microwave hyperthermia and adjuvant immunotherapy in the surgical treatment of bone tumors can be considered a definitive procedure, which is safe and well-tolerated.
保肢手术已被广泛应用于治疗恶性骨肿瘤。不幸的是,这些手术存在不同的问题。我们采用了一种联合微波诱导高温的替代手术来改进手术方法。采用微波体内照射热疗治疗112例骨肿瘤患者。在这个系列中,79例为恶性肿瘤,33例为侵袭性良性肿瘤。术后定期进行免疫治疗。通过检测T细胞亚群、IL-2和sIL-2R(可溶性IL-2受体)来监测患者的免疫功能。随访时间为3至50个月(平均23个月)。除5例因缓解症状而接受治疗的脊椎恶性肿瘤患者外,其余107例按肿瘤学和矫形标准进行评估。10例患者出现局部复发并需要截肢。其余97例局部控制良好。在74例四肢恶性肿瘤患者中,12例在术后4个月至2年出现肺转移。8例患者在失活骨处发生病理性骨折。在40例随访超过2年的无瘤病例中,29例膝关节功能正常,活动范围几乎完全正常。单光子发射计算机断层扫描(SPECT)研究显示,失活的肿瘤骨段在一年或更长时间内可实现血管再生。大多数患者在热疗加免疫治疗后免疫状态得到改善。这些结果表明,在骨肿瘤手术治疗中使用微波高温和辅助免疫治疗可被视为一种安全且耐受性良好的确定性手术。