Donati D, Giacomini S, Gozzi E, Ferrari S, Sangiorgi L, Tienghi A, DeGroot H, Bertoni F, Bacchini P, Bacci G, Mercuri M
Department of Musculoskeletal Oncology and Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
Eur J Surg Oncol. 2004 Apr;30(3):332-40. doi: 10.1016/j.ejso.2003.12.004.
To describe the outcomes of a large number of patients with pelvic osteosarcoma, and to define the guidelines for appropriate treatment.
We reviewed 60 consecutive patients with primary pelvic high-grade osteosarcoma. The tumour involved the whole hemipelvis in 15 cases, while the most common location was the iliac wing in 29 cases (48.3%): 25 of these adjacent to or passing the sacroiliac joint.
Thirty patients underwent surgery; there were 16 hindquarter amputations and 14 internal hemipelvectomies. All the patients who presented with metastasis died of their disease. In 18 cases wide margins were achieved, however, eight patients experienced local recurrence. Of the series, only eight patients are still alive.
The use of intense chemotherapy and surgical wide margin, hardly seems to achieve local control, however, tumour necrosis was correlated with positive prognosis. When internal hemipelvectomy it is not safe enough, amputation must be considered, particularly for cases with sacrifice of the sciatic nerve roots or for older patients where a shorter surgical procedure can be less risky.
描述大量骨盆骨肉瘤患者的治疗结果，并确定合适的治疗指南。
我们回顾性分析了60例连续性原发性骨盆高级别骨肉瘤患者。15例肿瘤累及整个半骨盆，最常见的部位是髂骨翼，共29例（48.3%）：其中25例邻近或经过骶髂关节。
30例患者接受了手术，其中16例行后躯截肢术，14例行半骨盆切除术。所有出现转移的患者均死于疾病。18例患者实现了广泛切缘，但8例患者出现局部复发。在该系列病例中，仅有8例患者仍存活。
采用强化化疗和手术广泛切缘，似乎很难实现局部控制，然而，肿瘤坏死与良好预后相关。当半骨盆切除术不够安全时，必须考虑截肢，特别是对于牺牲坐骨神经根的病例或老年患者，较短的手术过程风险可能较小。
