肢体隔离热灌注化疗术辅助治疗软组织肉瘤的12例报告  

Hyperthermic isolated limb perfusion chemotherapy as an adjunctive therapy for soft tissue sarcomas: twelve cases of report

作　　者：朱小军[1] 宋建民[1] 李晶[1] 付来华[1] 胡青烽[1] 

机构地区：[1]甘肃省肿瘤医院骨与软组织肿瘤科,兰州730050

出　　处：《中国骨与关节杂志》2015年第1期10-14,共5页Chinese Journal of Bone and Joint

摘　　要：目的：探讨术前肢体隔离热灌注化疗术辅助治疗局部晚期肢体软组织肉瘤（softtissue sarcoma，STS）的疗效。方法对2002年1月至2013年6月，我科收治的12例IIB期的肢体STS患者行肢体隔离热灌注化疗术。化疗后14～21天行原发病灶切除术，并行病理学检查。术后11例行6周期表柔比星＋异环磷酰胺（ epirubicin＋ifosfamide，AI ）方案的辅助化疗，1例行局部放射治疗。观察并记录肢体隔离热灌注化疗后肢体疼痛、肿胀程度、原发肿瘤的变化情况；术后随访观察术后疗效、局部复发、转移、并发症及化疗毒性反应等情况。肿瘤坏死情况评价肢体隔离热灌注化疗破坏肿瘤的情况；生化检查观察治疗后患者肝肾功能的变化；毒性反应评价采用Wieberdink分级标准。结果本组12例肢体隔离热灌注化疗后2天均出现患肢肿胀、皮温升高，化疗后7～10天达到高峰，化疗后10天肿胀逐渐消退、皮温逐渐下降，化疗后2周原发病灶表现为不同程度的肿瘤缩小、皮肤移动性增大、患肢周径缩小。化疗后3天，患者转氨酶有不同程度的升高，但均未超过正常值上限的4倍，未见肾功能异常变化。肿瘤坏死率≤60%者2例（16.66%），～90%者5例（41.67%），～100%者5例（41.67%）。12例均获得随访，平均随访（27.25±37.71）个月。1例达完全缓解（ complete response，CR ），5例达部分缓解（ partial response ，PR ），总缓解[ overall response，OR （ CR＋PR ）]率为50%。5例转移，2例局部复发并截肢，总局部复发率（ local recurrence，LR ）16.66%，总保肢率（ limb salvage，LS ）83.34%。1例跟腱挛缩者行跟腱延长术，恢复良好。1例肌间静脉血栓，给予溶栓治疗后治愈。Wieberdink毒性反应分级为I、II、III级，未见IV、V级毒性反应发生。结论术前肢体隔离热灌注化疗术辅助治疗肢体 STS 疗效满意，能明显杀灭肿瘤组织、降低�Objective To investigate the effects of preoperative hyperthermic isolated limb perfusion （ HILP ） chemotherapy as an adjunctive therapy for locally advanced soft tissue sarcomas of the limbs.Methods From January 2002 to June 2013, 12 patients with soft tissue sarcomas of the limbs （ stage II B ） underwent HILP chemotherapy. The primary lesions were removed at 14-21 days after the chemotherapy, and pathological examination was carried out. The adjunctive chemotherapy with the combination of epirubicin and ifosfamide （ AI ） was performed on 11 patients for 6 cycles after the operation. One patient was treated with local radiotherapy. Pain, swelling and changes of primary lesions in the limbs were observed and recorded after HILP chemotherapy. All the patients were followed up. The postoperative outcomes, local recurrences, metastases, complications and toxicity of chemotherapy were documented. The effects of HILP chemotherapy were evaluated according to the degree of tumor necrosis. The biochemical test was carried out to detect the changes of hepatic function and renal function. The toxicity of chemotherapy was graded according to Wieberdink et al.Results Limb swelling and increased skin temperature were noticed in 12 patients at 2 days after HILP chemotherapy, which peaked at 7-10 days after the chemotherapy. At 10 days after the chemotherapy, swelling disappeared and skin temperature was gradually decreased. Tumor reduction, increased mobility of the skin and diminished limb circumference to different degrees were found in primary lesions at 2 weeks after the chemistry.Elevation of aminopherase to different degrees was noticed in the patients at 3 days after the chemistry, which was not beyond 4 times of its normal upper limit value. Abnormal changes of the renal function were not detected. The tumor necrosis rate was 91%-100% in 5 patients （ 41.67% ）, 61%-90% in 5 patients （ 41.67% ） and 0%-60% in 2 patients （ 16.66% ）. All the 12 patients were followed up for a mean period of （ 27.25

关 键 词：化学疗法 肿瘤 局部灌注 软组织肿瘤 肉瘤 四肢 热灌注 

分 类 号：R738.6[医药卫生—肿瘤]