Schray M F, Gunderson L L, Sim F H, Pritchard D J, Shives T C, Yeakel P D
Division of Radiation Oncology, Mayo Clinic, Rochester, MN 55905.
Cancer. 1990 Aug 1;66(3):451-6. doi: 10.1002/1097-0142(19900801)66:3<451::aid-cncr2820660309>3.0.co;2-j.
Between December 1981 and August 1988, 63 patients with clinically localized nonretroperitoneal soft tissue sarcomas underwent 65 brachytherapy procedures in conjunction with conservative resection with (61 tumors) or without (four tumors) external beam irradiation. Implant doses of 1500 to 2000 cGy were combined with 4500 to 5000 cGy of external irradiation. External irradiation was given preoperatively for larger lesions near bone or neurovascular structures, whereas it was used postoperatively for smaller, more resectable lesions or those that had previously been inadequately excised. There were 47 high-grade tumors, 34 tumors greater than 5 cm, and nine patients with recurrent lesions (five with previous irradiation). With mean follow-up of 20 months, conclusions on local control are tentative, but only two of 56 tumors (4%) with brachytherapy as part of initial management had recurred locally and three of nine recurrent tumors had re-recurred locally. Only one of five local recurrences was within the implanted volume. Only two of 40 implantations (5%) performed at initial resection followed by postoperative external irradiation led to wound complications, whereas four of 16 implantations (25%) performed at resection after preoperative external irradiation were associated with wound problems. This technique does not increase local morbidity and may enhance local tumor control in comparison with either external radiation or brachytherapy alone as an adjuvant to conservative resection.
1981年12月至1988年8月期间，63例临床局限性非腹膜后软组织肉瘤患者接受了65次近距离放射治疗，同时进行了保守性切除，其中61例肿瘤联合了外照射，4例肿瘤未联合外照射。组织间植入剂量为1500至2000 cGy，并联合4500至5000 cGy的外照射。对于靠近骨骼或神经血管结构的较大病变，外照射在术前进行；而对于较小、更易切除的病变或先前切除不充分的病变，则在术后进行外照射。有47例高级别肿瘤，34例肿瘤直径大于5 cm，9例患者有复发病变（5例曾接受过照射）。平均随访20个月，关于局部控制的结论尚不确定，但在作为初始治疗一部分接受近距离放射治疗的56例肿瘤中，只有2例（4%）出现局部复发，9例复发性肿瘤中有3例再次出现局部复发。5例局部复发中只有1例在植入范围内。在初始切除后进行术后外照射的40次植入中，只有2例（5%）导致伤口并发症，而在术前外照射后切除时进行的16次植入中，有4例（25%）与伤口问题相关。与单独使用外照射或近距离放射治疗作为保守性切除的辅助治疗相比，该技术不会增加局部发病率，可能还会增强局部肿瘤控制。
