Volz Silvanie, Kalousis Konstantinos, Song Jung In, Kisch Tobias, Wenzel Eike, Mailänder Peter
Clinic of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Hell J Nucl Med. 2017 Sep-Dec;20 Suppl:163.
Interdisciplinary work including surgery and additive radiotherapy is often needed for the therapy of tumours. Beneath this, brachytherapy is an important part of the radiotherapy. It was first used over 100 years ago and is in regular use after the development of afterload technology in the early 1970s. Today it is often used in different tumour therapies, for example in soft tissue sarcoma or breast tumours, in order to decrease the risk of local recurrence. Concerning its benefits, higher doses could be used because of the localized effect with equivalent local control rate and less toxicity of treatment. Moreover, brachytherapy can also shorten the treatment time from 5-7 weeks to some days and is better reconcilable due to its localized effects, thus reducing side effects, as radiation-induced reactions, teleangiectasia and brosis. Precondition for application of brachytherapy is the need of a good soft tissue coverage and wound healing. Therefore, good interdisciplinary cooperation between plastic surgery and radiotherapy is important. After wide surgical resection reconstruction with different kind of flaps are often required, for achieving early wound healing and fast start of radiotherapy.
Between 2011 and 2017 we applied brachytherapy to 13 patients with soft tissue sarcomas and other tumours like merkel-cell-carcinoma, schwannoma, and breast cancer. The treatment consisted of tumour resection, intraoperative insertion of brachytherapy catheters and after that brachytherapy alone or in combination with external beam radiotherapy. In half of the patients a reconstruction with different flaps was required, including pedicled trapezius flap, musculus latissimus dorsi flap and radial forearm flap; in some cases nerve and tendon reconstruction for better function and faster wound healing and so faster start of postoperative brachytherapy was also needed. The mean age of the patients was 55 years (±19) and we could start brachytherapy after 3-21 days after the operation, with a mean start on day 8±5 postoperatively. Three patients received additional percutaneous radiotherapy. The patients who received only brachytherapy got a dose of 2, 5 or 3Gy twice daily, with a mean total dose of 31±3Gy.
Multidisciplinary work, including surgery as the main procedure and radiotherapy additionally, is needed for a successful treatment of soft tissue tumours. Depending on the type and the stadium of tumour plastic and reconstructive surgery provides soft tissue coverage, faster wound healing and the chance for limb salvage; on the other hand, additive brachytherapy contributes to a good tumour control. Therefore, a close collaboration between the two specialties is of particular importance, in order to improve the effectiveness of the therapy and the postoperative quality of life of the patient.
肿瘤治疗通常需要包括手术和辅助放疗在内的多学科协作。在此基础上，近距离放射治疗是放射治疗的重要组成部分。它于100多年前首次使用，在20世纪70年代初后装技术发展后开始常规应用。如今，它常用于不同的肿瘤治疗，例如软组织肉瘤或乳腺肿瘤，以降低局部复发风险。就其益处而言，由于局部效应，在局部控制率相当且治疗毒性较小的情况下，可以使用更高的剂量。此外，近距离放射治疗还可以将治疗时间从5至7周缩短至几天，并且由于其局部效应，更容易协调，从而减少诸如放射性反应、毛细血管扩张和纤维化等副作用。近距离放射治疗应用的前提条件是需要良好的软组织覆盖和伤口愈合。因此，整形外科和放疗科之间良好的多学科合作很重要。在广泛手术切除后，通常需要用不同类型的皮瓣进行重建，以实现早期伤口愈合并快速开始放疗。
2011年至2017年间，我们对13例软组织肉瘤及其他肿瘤患者（如默克尔细胞癌、神经鞘瘤和乳腺癌）应用了近距离放射治疗。治疗包括肿瘤切除、术中插入近距离放射治疗导管，之后单独进行近距离放射治疗或与外照射放疗联合使用。一半的患者需要用不同的皮瓣进行重建，包括带蒂斜方肌皮瓣、背阔肌皮瓣和桡侧前臂皮瓣；在某些情况下，还需要进行神经和肌腱重建以改善功能并加快伤口愈合，从而更快地开始术后近距离放射治疗。患者的平均年龄为55岁（±19岁），我们在术后3至21天开始进行近距离放射治疗，平均开始时间为术后第8±5天。3例患者接受了额外的经皮放疗。仅接受近距离放射治疗的患者每天接受2、5或3Gy的剂量，分两次给予，平均总剂量为31±3Gy。
软组织肿瘤的成功治疗需要多学科协作，包括以手术为主的治疗以及辅助放疗。根据肿瘤的类型和分期，整形和重建手术可提供软组织覆盖、加快伤口愈合并保留肢体；另一方面，辅助近距离放射治疗有助于良好地控制肿瘤。因此，两个专科之间的密切合作尤为重要，以提高治疗效果和患者的术后生活质量。
