软组织肉瘤高剂量率近距离放疗的早期并发症：与传统外照射放疗的比较。
Early complications of high-dose-rate brachytherapy in soft tissue sarcoma: a comparison with traditional external-beam radiotherapy.
机构信息
Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
出版信息
Clin Orthop Relat Res. 2012 Mar;470(3):751-8. doi: 10.1007/s11999-011-2106-5.
BACKGROUND
Radiotherapy and surgery are routinely utilized to treat extremity soft tissue sarcoma. Multiple radiation modalities have been described, each with advantages and disadvantages, without one modality demonstrating clear superiority over the others.
QUESTIONS/PURPOSES: We determined the overall initial complication rate in patients receiving surgery and radiotherapy, which specific complications were found when comparing different modalities, and whether combination therapy increased the overall rate of complications compared with surgery and single-modality radiotherapy.
PATIENTS AND METHODS
We retrospectively reviewed the records of 190 patients who received external-beam radiotherapy (141 patients), high-dose-rate brachytherapy (37 patients), or both (12 patients). We evaluated 100 men and 90 women (mean age, 57 years; range, 18-94 years) for tumor size and subtype, comorbidities, stage, grade, margin of resection, type of adjuvant treatment, and complications. Minimum followup was 3 months (mean, 40 months; range, 3-155 months).
RESULTS
The most frequent early complications in the high-dose-rate brachytherapy cohort were infection, cellulitis, and seroma and/or hematoma. In the external-beam radiotherapy cohort, chronic edema, fibrosis, and chronic radiation dermatitis were more frequently encountered. The total number of early complications and overall incidence of major complications requiring further surgery were similar among the three cohorts, but a larger number of patients in the high-dose-rate brachytherapy group required subsequent surgery for infection compared with the external-beam radiotherapy group.
CONCLUSIONS
High-dose-rate brachytherapy decreases radiation exposure and allows shorter duration of treatment compared with traditional external-beam radiotherapy but has a higher perioperative wound complication rate.
LEVEL OF EVIDENCE
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
放疗和手术是治疗肢体软组织肉瘤的常规方法。已经描述了多种放射治疗方式，每种方式都有其优缺点，但没有一种方式明显优于其他方式。
问题/目的：我们确定了接受手术和放疗的患者的总体初始并发症发生率，比较不同方式时发现了哪些具体并发症，以及与手术和单一模式放疗相比，联合治疗是否会增加总体并发症发生率。
患者和方法
我们回顾性分析了 190 例接受外照射放疗（141 例）、高剂量率近距离放疗（37 例）或两者联合治疗（12 例）的患者记录。我们评估了 100 名男性和 90 名女性（平均年龄 57 岁；范围，18-94 岁）的肿瘤大小和亚型、合并症、分期、分级、切除边缘、辅助治疗类型和并发症。随访时间至少为 3 个月（平均 40 个月；范围，3-155 个月）。
结果
高剂量率近距离放疗组最常见的早期并发症是感染、蜂窝织炎和血清肿和/或血肿。外照射放疗组更常见慢性水肿、纤维化和慢性放射性皮炎。三组之间早期并发症的总数量和需要进一步手术的主要并发症的总发生率相似，但高剂量率近距离放疗组中需要进一步手术治疗感染的患者数量多于外照射放疗组。
结论
与传统外照射放疗相比，高剂量率近距离放疗可减少辐射暴露并缩短治疗时间，但围手术期伤口并发症发生率较高。
证据水平
III 级，治疗研究。请参阅作者指南，以获取完整的证据水平描述。
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