四肢和关节附近软组织肉瘤术中电子线放疗的并发症和近期疗效  

Complications and short-term outcomes of intraoperative electron radiotherapy （ IOERT ） in patients with periarticular soft-tissue sarcomas of the extremities

作　　者：范诚诚[1] 冯勤付[1] 翟医蕊[1] 李明辉[1] 徐立斌[2] 赵志国[2] 陈辛元[1] 胡志辉[1] 张永谦[1] 于胜吉[2] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院放疗科,100021 [2]中国医学科学院北京协和医学院肿瘤医院,骨科100021

出　　处：《中华肿瘤杂志》2012年第4期311-315,共5页Chinese Journal of Oncology

摘　　要：目的研究术中电子线放疗（IOERT）对局部晚期和复发性四肢和关节附近软组织肉瘤（STS）术后近期局部控制和并发症的影响。方法收集21例行IOERT的四肢和关节附近STS患者的临床资料，分析患者的术中放疗后并发症、复发和转移情况，并对患者进行随访。结果3个月内皮肤急性毒性反应I级6例，Ⅱ级3例。2年晚期皮肤毒性I级4例，Ⅱ级2例。皮下纤维化I级3例，Ⅱ级3例。6例患者出现伤口愈合延迟。6例患者出现关节功能障碍，其中I级3例，Ⅱ级3例。4例患者术后疤痕区有疼痛。1例术中放疗后9个月疑似放射性坐骨神经炎，行营养神经治疗和神经松解术后症状缓解。5例患者治疗失败，其中局部复发1例，区域复发1例，远处转移2例，局部复发合并远处转移1例。1、2年局部控制率分别为95．2％和90．5％。随访时间8～29个月，中位随访时间15个月，截止到随访时间，所有患者均存活。结论IOERT治疗局部晚期和复发的四肢和关节附近STS，急慢性反应较轻，肿瘤近期局部控制率满意。增加术中照射剂量或术中放疗联合术后放疗，可获得更好的局部控制，并能减少并发症的发生。建议联合化疗以减少远处转移。Objective To analyze the complications and short-term outcomes of patients receiving intraoperative electron radiotherapy （IOERT） for locally advanced and recurrent periarticular soft tissue sarcomas of the extremities. Methods Twenty-one adult patients with locally advanced and/or recurrent periarticular soft tissue sarcomas of the extremities treated with IOERT were included in this study. Among them 14 patients had recurrent diseases after prior operation and 7 patients with locally advanced disease with primary treatment. The total dose of radiation ranged from 11 Gy to 21 Gy of 6-12 MeV beta ray given by intraoperative radiotherapy after complete tumor resection with negative margins. Five patients were given external beam radiotherapy （EBRT） with a total dose of 40-50 Gy, and 10 patients received chemotherapy. Results The median follow-up time was 15 months. Five patients （23.8%） had tumor relapse, including one patients with local recurrence, one patient with regional recurrence, two patients with distant metastasis and one patient with local recurrence and distant metastasis. The actuarial local control rate at 1 year was 95.2% （20/21）, and at 2 years was 90.5% （ 19/21 ）. Acute skin toxicity （RTOG） within 3 months after surgery included grade I in 6 patients and grade I1 in 3 patients. Two year late skin toxicity （ RTOG/ EORTC ） included grade I in 4 patients and grade I1 in 2 patients. Fibrosis included grade I in 3 patients and grade lI in 3 patients. Six patients had joint dysfunction （ 3 patients with grade I and 3 with grade II ） and 6 patients had healing problems. One patient got ipsilateral schiatic neuritis 9 months after IOERT. No adverse events occurred during surgery. Conclusions IOERT brings tolerable complications of acute and late toxicities and favorable local control rate. IOERT should be followed by postoperative radiotherapy or increase the intraoperative radiation dose for locally advanced and recurrent sarcomas to get a better localcontrol. Otherwise, d

关 键 词：肉瘤 四肢 术中电子线放疗 并发症 治疗结果 

分 类 号：R738.6[医药卫生—肿瘤]