Willeke F, Eble M J, Lehnert T, Schwarzbach M, Hinz U, Wannenmacher M, Herfarth C
Chirurgische Universitätsklinik Heidelberg.
Chirurg. 1995 Sep;66(9):899-904.
Sarcomas of the retroperitoneum are characterized by a high rate of local recurrence. External beam radiotherapy is known to improve local control after surgical therapy. To increase local dosage of radiotherapy without affection of sensitive structures we applied intraoperative radiotherapy (IORT) since 1991 in a dedicated operative unit. To compare morbidity and tumor control we used a partly historic control group of patients treated since 1988 for retroperitoneal soft tissue sarcoma. 25 patients with a mean age of 53 years were operated. Tumor histology was dominated by liposarcoma and leiomyosarcoma, UICC stage IIB (T2 G2 N0 M0) was present in 45% of cases. Distant metastasis were diagnosed in 19% at therapeutic intervention. Tumor free margins were achieved in 55% while 29% showed microscopic and 16% macroscopic tumor residues after surgical intervention. 11 patients received IORT with a mean of 18 Gy, eight of those patients were treated additionally with a mean of 40,4 Gy externally. There were no differences in distribution of known risk factors for recurrence in the group of patients treated with or without IORT. The analysis showed no difference for perioperative morbidity. Tolerance for IORT and additional external beam radiotherapy was good. Local tumor control tended to be improved by IORT (p = 0.082) while overall survival was not affected at a mean follow-up of 24 months.
腹膜后肉瘤的特点是局部复发率高。已知外照射放疗可改善手术治疗后的局部控制。为了在不影响敏感结构的情况下增加放疗局部剂量，自1991年起我们在一个专门的手术单元中应用了术中放疗（IORT）。为了比较发病率和肿瘤控制情况，我们使用了一个部分为历史对照的患者组，这些患者自1988年起接受腹膜后软组织肉瘤治疗。25例患者接受了手术，平均年龄53岁。肿瘤组织学以脂肪肉瘤和平滑肌肉瘤为主，45%的病例为UICC IIB期（T2 G2 N0 M0）。在治疗干预时，19%的患者被诊断为远处转移。55%的患者实现了切缘无肿瘤，而29%的患者术后有镜下肿瘤残留，16%的患者有肉眼可见的肿瘤残留。11例患者接受了IORT，平均剂量为18 Gy，其中8例患者还额外接受了平均40.4 Gy的外照射放疗。接受或未接受IORT治疗的患者组中，已知的复发危险因素分布没有差异。分析显示围手术期发病率没有差异。IORT和额外的外照射放疗耐受性良好。IORT有改善局部肿瘤控制的趋势（p = 0.082），而在平均24个月的随访中，总生存率未受影响。
