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手术联合术中近距离放射治疗在腹膜后肉瘤治疗中的应用

Surgery combined with intraoperative brachytherapy in the treatment of retroperitoneal sarcomas.

作者信息

Dziewirski Wirginiusz, Rutkowski Piotr, Nowecki Zbigniew I, Sałamacha Maciej, Morysiński Tadeusz, Kulik Anna, Kawczyńska Maria, Kasprowicz Anetta, Lyczek Jarosław, Ruka Włodzimierz

机构信息

Department of Soft Tissue/Bone Sarcoma, M. Sklodowska-Curie Cancer Center and Institute of Oncology, W.K. Roentgena Str. 5, Warsaw, 02-781, Poland.

出版信息

Ann Surg Oncol. 2006 Feb;13(2):245-52. doi: 10.1245/ASO.2006.03.026. Epub 2006 Jan 17.

Abstract

BACKGROUND

The purpose of this study was to analyze the results of treatment of retroperitoneal soft tissue sarcomas (RSTS) by surgery combined with intraoperative brachytherapy (IOBRT).

METHODS

Seventy adult patients with RSTS were considered for combined treatment (surgery plus IOBRT) between June 1998 and February 2004. There were 64 (91%) recurrent tumors, and 93% of tumors exceeded 5 cm. IOBRT was performed with high-dose-rate Gammamed 12 with iridium 192 (IOBRT time range, 20-87 minutes; median, 56 minutes).

RESULTS

After intraoperative re-evaluation, 24 patients (34%) were found to be ineligible for IOBRT because of multiple intraperitoneal recurrences, macroscopically nonradical resection, poor general condition, and technical aspects. Thirty-seven patients underwent IOBRT immediately after surgery during the same general anesthesia procedure. Nine patients underwent delayed IOBRT within 1 to 3 days after the primary operation. Ten (21.5%) of 46 patients underwent reoperation because of surgical complications. One patient died in the postoperative period. After IOBRT, 24 patients (52%) underwent adjuvant external beam radiotherapy (EBRT) to a total dose of 50 Gy. Over a median follow-up time of 20 months, the estimated 5-year overall survival and local recurrence-free survival rates in IOBRT patients were 55% and 51%, respectively. Application of adjuvant EBRT showed a favorable local control rate.

CONCLUSIONS

The scheduled combined treatment (surgery plus IOBRT) was possible to perform in 66% of RSTS cases that received surgical treatment. The complication rate was high, but we consider it acceptable because of the necessity for extensive aggressive surgical treatment in regionally advanced RSTS. EBRT seems to be an indispensable part of treatment that provides better local control.

摘要

背景

本研究的目的是分析手术联合术中近距离放疗(IOBRT)治疗腹膜后软组织肉瘤(RSTS)的结果。

方法

1998年6月至2004年2月期间,70例成年RSTS患者接受了联合治疗(手术加IOBRT)。其中64例(91%)为复发性肿瘤,93%的肿瘤直径超过5 cm。IOBRT采用高剂量率的Gammamed 12铱192进行(IOBRT时间范围为20 - 87分钟;中位数为56分钟)。

结果

术中重新评估后,24例患者(34%)因腹腔内多处复发、肉眼下切除不彻底、全身状况差以及技术因素而不符合IOBRT治疗条件。37例患者在同一全麻手术过程中术后立即接受了IOBRT。9例患者在初次手术后1至3天内接受了延迟IOBRT。46例患者中有10例(21.5%)因手术并发症接受了再次手术。1例患者在术后死亡。IOBRT后,24例患者(52%)接受了辅助外照射放疗(EBRT),总剂量为50 Gy。中位随访时间为20个月,接受IOBRT治疗患者的5年总生存率和局部无复发生存率估计分别为55%和51%。辅助EBRT的应用显示出良好的局部控制率。

结论

在接受手术治疗的RSTS病例中,66%的患者可以进行预定的联合治疗(手术加IOBRT)。并发症发生率较高,但由于局部晚期RSTS需要进行广泛积极的手术治疗,我们认为这是可以接受的。EBRT似乎是治疗中不可或缺的一部分,可提供更好的局部控制。

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