经皮病灶内刮除术联合冷冻手术治疗低度软骨肉瘤的长期疗效。

Long-term results of intralesional curettage and cryosurgery for treatment of low-grade chondrosarcoma.

机构信息

Washington Cancer Institute, Washington Hospital Center, Georgetown University, 110 Irving Street N.W., Room CI-2158, Washington, DC 20010, USA.

出版信息

J Bone Joint Surg Am. 2013 Aug 7;95(15):1358-64. doi: 10.2106/JBJS.L.00442.

DOI:10.2106/JBJS.L.00442

PMID:23925739

Abstract

BACKGROUND

Data regarding outcomes following intralesional curettage and cryosurgical treatment of low-grade chondrosarcoma of bone are limited. The aim of this study was to assess the long-term oncologic and functional outcomes of two different cryosurgery techniques.

METHODS

Forty-three low-grade chondrosarcoma lesions (in forty-two patients) were treated with intralesional curettage and cryosurgery from June 1983 to October 2006. Eleven lesions were treated with cryoprobes and thirty-two were treated with the modified direct-pour Marcove technique. The mean patient age was 44.9 ± 11.3 years (range, 21.8 to 66.4 years), and the mean duration of follow-up was 10.2 ± 4.6 years (range, five to 22.5 years). Indications for treatment included a radiographic appearance consistent with a cartilage tumor with evidence of aggressive behavior. Pearson correlation and multivariate analyses were used to evaluate the relationships between predictive factors (including lesion size, soft-tissue extension, and location, patient age, cortical erosion, and presence of preoperative pain) and outcomes.

RESULTS

The mean overall Musculoskeletal Tumor Society (MSTS) score was 26.5 ± 3.1 (range, 17 to 30). There were four local recurrences, all in patients who had had tumor extension out of the bone with soft-tissue involvement at initial presentation. The mean time to recurrence was 2.4 ± 2.3 years (range, 0.6 to 5.6 years). No patients developed metastatic disease during the follow-up period. There were no differences between the cryoprobe and Marcove techniques with respect to the MSTS score, fracture, or local recurrence. A significant correlation between tumor recurrence and soft-tissue extension was found (r = 0.79). Kaplan-Meier survivorship, with freedom from recurrence as the end point, was 90.7%.

CONCLUSIONS

Intralesional curettage and cryosurgery for low-grade chondrosarcoma is safe and effective in selected patients. The presence of preoperative cortical breakthrough and soft-tissue extension was the strongest predictor of local recurrence following use of this technique.

LEVEL OF EVIDENCE

Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.

摘要

背景

关于骨内部分切除术和冷冻治疗低度软骨肉瘤的结果数据有限。本研究的目的是评估两种不同冷冻技术的长期肿瘤学和功能结果。

方法

1983 年 6 月至 2006 年 10 月，对 42 例患者的 43 个低度软骨肉瘤病变进行了内部分切除术和冷冻治疗。11 个病变采用冷冻探针治疗，32 个病变采用改良直接倾洒 Marcove 技术治疗。患者平均年龄为 44.9 ± 11.3 岁（范围为 21.8 岁至 66.4 岁），平均随访时间为 10.2 ± 4.6 年（范围为 5 年至 22.5 年）。治疗的适应证包括影像学表现符合软骨肿瘤，且具有侵袭性行为的证据。采用 Pearson 相关性和多变量分析评估预测因素（包括病变大小、软组织延伸和位置、患者年龄、皮质侵蚀和术前疼痛存在）与结果之间的关系。

结果

平均总体肌肉骨骼肿瘤学会（MSTS）评分为 26.5 ± 3.1（范围为 17 至 30）。有 4 例局部复发，均发生在初始表现为肿瘤超出骨并伴有软组织受累的患者中。复发的平均时间为 2.4 ± 2.3 年（范围为 0.6 年至 5.6 年）。在随访期间，无患者发生转移性疾病。冷冻探针和 Marcove 技术在 MSTS 评分、骨折或局部复发方面无差异。肿瘤复发与软组织延伸之间存在显著相关性（r = 0.79）。以无复发为终点的 Kaplan-Meier 生存分析显示，无复发率为 90.7%。