Bray P W, Bell R S, Bowen C V, Davis A, O'Sullivan B
University Musculoskeletal Oncology Unit, University of Toronto, Mount Sinai Hospital, Ontario, Canada.
J Hand Surg Am. 1997 May;22(3):495-503. doi: 10.1016/S0363-5023(97)80019-6.
Twenty-five consecutive patients with soft tissue sarcoma of the forearm and hand were assessed for limb-salvage surgery and were entered into a prospective study evaluating oncologic details and functional outcome. Seventeen patients had received incomplete primary excision elsewhere and presented with local recurrence or residual disease. Three had pulmonary metastases at the time of presentation. Twenty-three patients were candidates for limb-salvage surgery and 20 received adjuvant radiotherapy. The mean follow-up period was 37 months. There was local recurrence in three patients who had initially received marginal excision of the primary sarcoma, and three patients died of systemic disease. Limb function was assessed prospectively using both patient-based and clinician-based functional scoring systems and revealed good to excellent results in all but three patients. Eighty-eight percent of those who survived and did not require amputation were able to return to occupational and activities of daily living with no or minimal functional limitation. This study demonstrates that limb-salvage surgery, with adjuvant radiotherapy when necessary, is an effective alternative to amputation in the majority of patients with sarcoma of the forearm and hand. Radiation toxicity is rarely a problem.
对25例连续性前臂和手部软组织肉瘤患者进行保肢手术评估，并纳入一项前瞻性研究，评估肿瘤学细节和功能结局。17例患者在其他地方接受了不完全的初次切除，出现局部复发或残留疾病。3例患者在就诊时已有肺转移。23例患者适合保肢手术，20例接受了辅助放疗。平均随访期为37个月。3例最初接受原发性肉瘤边缘切除的患者出现局部复发，3例患者死于全身性疾病。采用基于患者和基于临床医生的功能评分系统对肢体功能进行前瞻性评估，结果显示除3例患者外，其他患者的结果均为良好至优秀。88%存活且无需截肢的患者能够恢复工作和日常生活活动，功能受限极小或无功能受限。本研究表明，对于大多数前臂和手部肉瘤患者，保肢手术在必要时联合辅助放疗是截肢的有效替代方法。放射毒性很少成为问题。
