Nagashima T, Yamamuro T, Kotoura Y, Takahashi M, Abe M, Nakashima Y
Nihon Seikeigeka Gakkai Zasshi. 1983 Nov;57(11):1681-97.
At the Department of Orthopaedic Surgery of Kyoto University Hospital, intra-operative radiotherapy by the high dose electron irradiation has so far been used in treating patients with osteosarcoma. The dose distribution was calculated by CT-number so that the focus was subject to at least 80% of the irradiation doses and the surgically opened lesion was irradiated with 5,000 rad of 12-26 MeV electron beams. In order to accurately assess its therapeutic effect, histological studies were conducted on 9 patients who underwent en bloc resection or amputation following irradiation treatment for osteosarcoma. Method The excised specimen was sagittally cut in half and was fixed in 10% neutral buffered formalin. The specimen was cut into 5 mm thick sections corresponding to CT cross sections. At the border region between irradiated and non-irradiated fields, specimens were prepared using sagittal sections to compare the histological findings of both fields. After all specimens were carefully macroscopically examined and then photographed with soft-X-ray film, some of them were prepared as non- delimed specimens in polyester resin and were observed by contact microradiography and fluorescent microscopy. The remaining specimens after deliming in Plank - Rychlo solution were sliced to 4-8 micron thick for study as large specimen stained with hematoxylin and eosin. Four patients had been administered tetracycline 3 days preoperatively. Results Histologically the changes of the specimens were evaluated using the Oohoshi and Shimosato 's criteria for the histological effects of irradiation. In two of the 9 patients, who had received unidirectional irradiation, the survival of Grade 2a-2b tumor tissue was observed in the superficial layers both inside and outside the periosteum. Six patients who were irradiated from both sides or three directions, showed complete necrosis in extremely small areas of Grade 2b-3 change of tumor cells. Only one of these 9 patients had a local recurrence after the irradiation. Marked fluorescence was observed in the recurrent tissue by tetracycline labeling, but no fluorescence was observed in any of the other cases in the tumorous tissues which had fallen within the range of irradiation. These findings strongly suggest that intra-operative irradiation is extremely effective in controlling local osteosarcoma lesion in the extremities.
在京都大学医院骨外科，高剂量电子照射术中放疗迄今一直用于治疗骨肉瘤患者。通过CT值计算剂量分布，使肿瘤灶接受至少80%的照射剂量，并用12 - 26MeV电子束对手术切开的病灶给予5000拉德的照射。为准确评估其治疗效果，对9例骨肉瘤照射治疗后接受整块切除或截肢的患者进行了组织学研究。方法 将切除的标本矢状面切成两半，固定于10%中性缓冲福尔马林中。标本切成对应于CT横断面的5毫米厚切片。在照射野与未照射野的边界区域，用矢状切片制备标本，以比较两野的组织学表现。所有标本经仔细大体检查后用软X线胶片拍照，部分标本制成聚酯树脂包埋的未脱钙标本，用接触式显微放射摄影和荧光显微镜观察。其余标本在普兰克 - 里克洛溶液中脱钙后切成4 - 8微米厚，作为苏木精和伊红染色的大体标本进行研究。4例患者术前3天给予四环素。结果 组织学上，根据大星和下里的照射组织学效应标准对标本变化进行评估。9例接受单向照射的患者中，2例在骨膜内外表层观察到2a - 2b级肿瘤组织存活。6例从两侧或三个方向照射的患者，在肿瘤细胞2b - 3级改变的极小区域出现完全坏死。这9例患者中只有1例照射后局部复发。复发组织经四环素标记观察到明显荧光，但在照射范围内的肿瘤组织其他病例中均未观察到荧光。这些结果强烈提示术中照射在控制肢体局部骨肉瘤病灶方面极为有效。
