CAJ | 학술논문

目的评价术中电子线放射治疗技术在肢体关节周围骨与软组织恶性肿瘤保肢手术中的应用价值.方法 2008年10月至2012年4月间,应用术中电子线放射治疗技术联合保肢手术治疗肢体关节周围骨与软组织恶性肿瘤患者19例,其中肿瘤位于膝关节周围8例,髋关节周围6例,肘关节周围4例,肩关节周围1例.所有患者均行保肢手术,其中R0切除18例,R1切除1例.术中照射剂量为10 ～ 22 Gy,中位19 Gy.采用单野照射9例,采用多野多次照射10例.结果全组19例患者中,出现伤口愈合不良、感染和皮下积液等7例(36.8％),未出现Ⅲ级或以上急性放射损伤.1例(5.3％)患者于术后15个月出现放射性溃疡,形成动脉瘘,急诊行截肢术.按照1993年美国骨肿瘤学会评分系统标准,全组患者的肢体功能评分为(26.26±4.04)分,关节功能总的优良率为94.7％ (18/19).4例(21.1％)患者出现局部复发,全组患者的1、2和3年局部控制率分别为81.9％、73.7％和73.7％.7例(36.8％)患者死亡,全组患者的1、2和3年生存率分别为76.3％、61.2％和51.0％.结论应用术中电子线放射治疗技术联合保肢手术治疗肢体关节周围骨与软组织恶性肿瘤,患者的急慢性不良反应较轻,临床安全性较高,肿瘤的局部控制率高,并可尽可能地保留肢体关节功能,提高患者的生活质量.
목적 평개술중전자선방사치료기술재지체관절주위골여연조직악성종류보지수술중적응용개치.방법 2008년10월지2012년4월간,응용술중전자선방사치료기술연합보지수술치료지체관절주위골여연조직악성종류환자19례,기중종류위우슬관절주위8례,관관절주위6례,주관절주위4례,견관절주위1례.소유환자균행보지수술,기중R0절제18례,R1절제1례.술중조사제량위10 ～ 22 Gy,중위19 Gy.채용단야조사9례,채용다야다차조사10례.결과 전조19례환자중,출현상구유합불량、감염화피하적액등7례(36.8％),미출현Ⅲ급혹이상급성방사손상.1례(5.3％)환자우술후15개월출현방사성궤양,형성동맥루,급진행절지술.안조1993년미국골종류학회평분계통표준,전조환자적지체공능평분위(26.26±4.04)분,관절공능총적우량솔위94.7％ (18/19).4례(21.1％)환자출현국부복발,전조환자적1、2화3년국부공제솔분별위81.9％、73.7％화73.7％.7례(36.8％)환자사망,전조환자적1、2화3년생존솔분별위76.3％、61.2％화51.0％.결론 응용술중전자선방사치료기술연합보지수술치료지체관절주위골여연조직악성종류,환자적급만성불량반응교경,림상안전성교고,종류적국부공제솔고,병가진가능지보류지체관절공능,제고환자적생활질량.
Objective To evaluate the value of intraoperative radiation therapy with electrons (ELIOT) in treatment of malignant bone or soft tissue tumors around the joints.Methods From October 2008 to April 2012,nineteen patients with malignant bone or soft tissue tumors around the joints were treated with ELIOT.The tumors were located around the knee joint in 8 patients,around the hip joint in 6 patients,around the elbow joint in 4 patients and around the shoulder joint in one patient.All of the patients underwent limb salvage surgeries.R0 resections were performed in 18 patients,while R1 resection was performed in one patient.The doses of intraoperative radiation ranged from 10 Gy to 22 Gy.The median dose was 19 Gy.More than one ELIOT fields were used in 10 patients because of the large tumor size.Results Seven patients suffered wound complications.No grade ≥ 3 acute toxicities were observed.One patient developed radiation ulcer and arterial fistula 15 months after surgery and ELIOT,and resulted in amputation finally (grade 4 late toxicity).The mean Musculoskeletal Tumor Society (MSTS) 93 score was 26.26 ± 4.04 (87.5％ ±13.5％),with excellent to good extremity functions in 18 patients (94.7％).Four patients had local recurrences.The estimated locoregional control rates at 1,2,and 3 years were 81.9％,73.7％,and 73.7％,respectively.Seven patients died of the diseases.The estimated overall survivals of the entire group of patients at 1,2,and 3 years were 76.3％,61.2％,and 51.0％,respectively.Conclusions ELIOT is a safe and well-tolerable technique and could be widely used for patients with malignant bone or soft tissue tumors around the joints with acceptable rates of acute and late toxicity.There is positive significance for controlling the tumor local recurrence,preserving the joint function and improving survival quality.