Allen Michael, Silvino Daniella, Kamrava Mitchell, Shon Wonwoo, Brien Earl
Department of Orthopaedic Surgery, Community Memorial Health System, 147 N Brent St. Ventura, CA 93003, United States of America.
NYIT College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, NY 1145, United States of America.
Int J Surg Case Rep. 2021 Jun;83:106005. doi: 10.1016/j.ijscr.2021.106005. Epub 2021 May 21.
Large high-grade sarcomas are commonly managed with five weeks of pre-operative radiation with chemotherapy followed by surgical resection. Wound complications occur in about one out of three patients with this regimen. Hypofractionated radiation therapy (HFRT) is a developing pre-operative approach that delivers radiation over a shorter duration of 5-10 treatments.
Two patients underwent HFRT with neoadjuvant chemotherapy followed by tumor resection. The first patient had high-grade de-differentiated liposarcoma, and the second patient a high-grade myxofibrosarcoma. Neither patient developed post-operative wound complications despite the massive tumor size.
Less is understood regarding rates and risk factors associated with wound complications using this shortened radiation approach. With attention to surgical detail, and advancing radiation delivery technologies, rates of complications can be minimized.
We discuss our experience with a neoadjuvant hypofractionated chemoradiation protocol in two patients with large volume sarcomas resected from the chest wall and the thigh who did not develop acute wound complications. Further evaluation of this shortened regimen is warranted.
大型高级别肉瘤通常采用术前放疗五周并联合化疗，随后进行手术切除的治疗方案。采用该方案治疗的患者中，约三分之一会出现伤口并发症。短程放疗（HFRT）是一种正在发展的术前治疗方法，其放疗疗程较短，为5至10次治疗。
两名患者接受了新辅助化疗联合HFRT，随后进行肿瘤切除。首例患者为高级别去分化脂肪肉瘤，第二例患者为高级别黏液纤维肉瘤。尽管肿瘤体积巨大，但两名患者均未出现术后伤口并发症。
对于采用这种缩短放疗方案时伤口并发症的发生率及相关危险因素，我们了解得较少。通过关注手术细节并改进放疗技术，可以将并发症发生率降至最低。
我们讨论了在两名分别从胸壁和大腿切除的巨大肉瘤患者中应用新辅助短程放化疗方案的经验，这两名患者均未出现急性伤口并发症。有必要对这种缩短的治疗方案进行进一步评估。
