Yu Jeong Il, Lim Do Hoon, Park Hee Chul, Nam Heerim, Kim Bo Kyoung, Kim Sung-Joo, Park Jae Berm
Department of Radiation Oncology, Samsung Medical Center Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Department of Radiation Oncology, Sheikh Khalifa Specialist Hospital, Ras Al Khaimah, United Arab Emirates Department of Surgery, Samsung Medical Center, Seoul, Republic of Korea.
Medicine (Baltimore). 2016 Jul;95(28):e4123. doi: 10.1097/MD.0000000000004123.
We investigated the efficacy and safety of a tissue expander (TE) for adjuvant radiotherapy (RT) of resected retroperitoneal sarcoma (RPS).This study was conducted with 37 patients with RPS who received resection with or without TE insertion followed by RT from August 2006 to June 2012 at Samsung Medical Center. Among the 37 patients, TE was inserted in 19. The quality of TE insertion was evaluated according to the correlation of clinical target volume and retroperitoneal surface volume covered by TE and was defined as follows: excellent, ≥85%; good, 70% to 85%; fair, 50% to 70%; and poor, <50%. The median follow-up period after surgery was 47.9 months (range, 5.5-85.5 months).The quality of TE insertion was excellent in 7 (36.8%), good in 5 (26.3%), fair in 4 (21.0%), and poor in 3 (16.7%) patients. A significantly higher biologically equivalent dose (BED, α/β = 10) was used in patients who had TE insertion (median, 64.8 vs. 60.0 Gy, P = 0.01). Local control was 39.7%, and overall survival was 76.4% at 5 years. Local control was significantly higher in patients who received ≥65 Gy of BED, 100.0% in contrast to 22.8% (P = 0.01). One patient with a history of multiple tumor resections showed abdominal infection with duodenal perforation of uncertain cause but had the potential of being related to TE and/or RT. Otherwise there were no ≥grade III acute or late toxicities.TE for adjuvant RT in RPS is feasible for delivering a higher RT dose with acceptable toxicity.
我们研究了组织扩张器（TE）在接受手术切除的腹膜后肉瘤（RPS）辅助放疗（RT）中的疗效和安全性。本研究纳入了37例RPS患者，这些患者于2006年8月至2012年6月在三星医疗中心接受了手术切除，部分患者在术中植入或未植入TE，术后接受了放疗。37例患者中，19例植入了TE。根据TE覆盖的临床靶区体积与腹膜后表面体积的相关性对TE植入质量进行评估，定义如下：优秀，≥85%；良好，70%至85%；中等，50%至70%；差，<50%。术后中位随访期为47.9个月（范围5.5 - 85.5个月）。TE植入质量优秀的患者有7例（36.8%），良好的有5例（26.3%），中等的有4例（21.0%），差的有3例（16.7%）。植入TE的患者使用了显著更高的生物等效剂量（BED，α/β = 10）（中位剂量，64.8 vs. 60.0 Gy，P = 0.01）。5年时局部控制率为39.7%，总生存率为76.4%。接受≥65 Gy BED的患者局部控制率显著更高，为100.0%，而接受较低剂量的患者为22.8%（P = 0.01）。1例有多次肿瘤切除史的患者出现腹部感染伴十二指肠穿孔，病因不明，但可能与TE和/或放疗有关。除此之外，未出现≥III级急性或晚期毒性反应。TE用于RPS的辅助放疗在给予更高放疗剂量的同时具有可接受的毒性，是可行的。
