经导管动脉栓塞治疗恶性骨与软组织肉瘤。II. 临床结果。

Transcatheter arterial embolization for malignant osseous and soft tissue sarcomas. II. Clinical results.

作者信息

Nagata Y, Mitsumori M, Okajima K, Mizowaki T, Fujiwara K, Sasai K, Nishimura Y, Hiraoka M, Abe M, Shimizu K, Kotoura Y

机构信息

Department of Radiology, Kyoto University Hospital, Japan.

出版信息

Cardiovasc Intervent Radiol. 1998 May-Jun;21(3):208-13. doi: 10.1007/s002709900246.

DOI:10.1007/s002709900246

PMID:9626436

Abstract

PURPOSE

To evaluate the clinical effects of transcatheter arterial embolization (TAE) on malignant bone and soft tissue tumors.

METHODS

TAE was performed in 10 patients with primary bone and soft tissue sarcomas and in 31 patients with metastatic bone tumors. The embolized arteries were the internal iliac artery in 30 cases, the intercostal artery in six cases, the lumbar artery in five cases, the suprascapular artery in three cases, and the iliolumbar artery, the internal pudendal artery, and the lateral sacral artery in one case each. The embolized material was gelatin sponge particles. The chemotherapeutic drugs were usually 20-40 mg of doxorubicin for primary and metastatic tumors and 50-100 mg of cisplatin only for primary tumors. In addition, 50-60 Gy of 10-MV radiotherapy with or without radiofrequency (RF)-capacitive hyperthermia in four sessions was administered before TAE for primary tumors only.

RESULTS

Even though the pain score increased immediately after TAE, 30 of 38 (79%) patients with pain (8 of 9 with primary tumors, and 22 of 29 with metastases) achieved pain control after TAE. A necrotic low-density area shown by computed tomography (CT) after TAE was found in 31 of 41 (76%) tumors [8 of 10 (80%) with primary tumors, and 23 of 31 (74%) with metastatic tumors]. The tumor size decreased in 14 of 25 (56%) primary and metastatic tumors after 3 months. Osteosclerotic changes appeared in two cases of metastatic tumors after 6 months. In five tumors resected after TAE, large areas of necrosis within the tumor were confirmed histologically. Transient local pain and numbness appeared after TAE, but were relieved by drug treatment within 1 week. No severe complications except a case of gluteal muscle necrosis were encountered after TAE. The 1-year survival rate of the patients with primary tumors was 38.1%, and the median survival was 18 months. The longest survival was 84 months. The 1-year survival rate of the patients with metastatic bone tumors was 38.9%; the median survival was 12 months. The longest survival was 24 months.

CONCLUSION

TAE could be an effective treatment for pain control and local control of malignant bone and soft-tissue tumors.

摘要

目的

评估经导管动脉栓塞术（TAE）对恶性骨与软组织肿瘤的临床疗效。

方法

对10例原发性骨与软组织肉瘤患者及31例转移性骨肿瘤患者实施TAE。栓塞动脉包括：髂内动脉30例，肋间动脉6例，腰动脉5例，肩胛上动脉3例，髂腰动脉、阴部内动脉及骶外侧动脉各1例。栓塞材料为明胶海绵颗粒。化疗药物方面，原发性和转移性肿瘤通常使用20 - 40mg阿霉素，仅原发性肿瘤使用50 - 100mg顺铂。此外，仅对原发性肿瘤在TAE前给予4次10 - MV放疗，剂量为50 - 60Gy，可联合或不联合射频（RF）电容式热疗。

结果

尽管TAE后疼痛评分立即升高，但38例疼痛患者中的30例（79%）（原发性肿瘤9例中的8例，转移性肿瘤29例中的22例）在TAE后实现了疼痛控制。TAE后计算机断层扫描（CT）显示坏死低密度区的情况为：41例肿瘤中的31例（76%）[原发性肿瘤10例中的8例（80%），转移性肿瘤31例中的23例（74%）]。3个月后，25例原发性和转移性肿瘤中的14例（56%）肿瘤大小缩小。6个月后，2例转移性肿瘤出现骨硬化改变。在TAE后切除的5个肿瘤中，组织学证实肿瘤内有大片坏死。TAE后出现短暂局部疼痛和麻木，但经药物治疗1周内缓解。TAE后除1例臀肌坏死外未出现严重并发症。原发性肿瘤患者的1年生存率为38.1%，中位生存期为18个月。最长生存期为84个月。转移性骨肿瘤患者的1年生存率为38.9%；中位生存期为12个月。最长生存期为24个月。