CAJ | 학술논문

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、降低术后局部复发率、改善患者的预后、副反应较小、安全性较高，对局部晚期软组织肿瘤的保肢具有重要作用。目的：探討術前肢體隔離熱灌註化療術輔助治療跼部晚期肢體軟組織肉瘤(softtissue sarcoma，STS)的療效。方法對2002年1月至2013年6月，我科收治的12例IIB期的肢體STS患者行肢體隔離熱灌註化療術。化療後14～21天行原髮病竈切除術，併行病理學檢查。術後11例行6週期錶柔比星＋異環燐酰胺( epirubicin＋ifosfamide，AI )方案的輔助化療，1例行跼部放射治療。觀察併記錄肢體隔離熱灌註化療後肢體疼痛、腫脹程度、原髮腫瘤的變化情況；術後隨訪觀察術後療效、跼部複髮、轉移、併髮癥及化療毒性反應等情況。腫瘤壞死情況評價肢體隔離熱灌註化療破壞腫瘤的情況；生化檢查觀察治療後患者肝腎功能的變化；毒性反應評價採用Wieberdink分級標準。結果本組12例肢體隔離熱灌註化療後2天均齣現患肢腫脹、皮溫升高，化療後7～10天達到高峰，化療後10天腫脹逐漸消退、皮溫逐漸下降，化療後2週原髮病竈錶現為不同程度的腫瘤縮小、皮膚移動性增大、患肢週徑縮小。化療後3天，患者轉氨酶有不同程度的升高，但均未超過正常值上限的4倍，未見腎功能異常變化。腫瘤壞死率≤60%者2例(16.66%)，～90%者5例(41.67%)，～100%者5例(41.67%)。12例均穫得隨訪，平均隨訪(27.25±37.71)箇月。1例達完全緩解( complete response，CR )，5例達部分緩解( partial response ，PR )，總緩解[ overall response，OR ( CR＋PR )]率為50%。5例轉移，2例跼部複髮併截肢，總跼部複髮率( local recurrence，LR )16.66%，總保肢率( limb salvage，LS )83.34%。1例跟腱攣縮者行跟腱延長術，恢複良好。1例肌間靜脈血栓，給予溶栓治療後治愈。Wieberdink毒性反應分級為I、II、III級，未見IV、V級毒性反應髮生。結論術前肢體隔離熱灌註化療術輔助治療肢體 STS 療效滿意，能明顯殺滅腫瘤組織、降低術後跼部複髮率、改善患者的預後、副反應較小、安全性較高，對跼部晚期軟組織腫瘤的保肢具有重要作用。
목적：탐토술전지체격리열관주화료술보조치료국부만기지체연조직육류(softtissue sarcoma，STS)적료효。방법대2002년1월지2013년6월，아과수치적12례IIB기적지체STS환자행지체격리열관주화료술。화료후14～21천행원발병조절제술，병행병이학검사。술후11례행6주기표유비성＋이배린선알( epirubicin＋ifosfamide，AI )방안적보조화료，1례행국부방사치료。관찰병기록지체격리열관주화료후지체동통、종창정도、원발종류적변화정황；술후수방관찰술후료효、국부복발、전이、병발증급화료독성반응등정황。종류배사정황평개지체격리열관주화료파배종류적정황；생화검사관찰치료후환자간신공능적변화；독성반응평개채용Wieberdink분급표준。결과본조12례지체격리열관주화료후2천균출현환지종창、피온승고，화료후7～10천체도고봉，화료후10천종창축점소퇴、피온축점하강，화료후2주원발병조표현위불동정도적종류축소、피부이동성증대、환지주경축소。화료후3천，환자전안매유불동정도적승고，단균미초과정상치상한적4배，미견신공능이상변화。종류배사솔≤60%자2례(16.66%)，～90%자5례(41.67%)，～100%자5례(41.67%)。12례균획득수방，평균수방(27.25±37.71)개월。1례체완전완해( complete response，CR )，5례체부분완해( partial response ，PR )，총완해[ overall response，OR ( CR＋PR )]솔위50%。5례전이，2례국부복발병절지，총국부복발솔( local recurrence，LR )16.66%，총보지솔( limb salvage，LS )83.34%。1례근건련축자행근건연장술，회복량호。1례기간정맥혈전，급여용전치료후치유。Wieberdink독성반응분급위I、II、III급，미견IV、V급독성반응발생。결론술전지체격리열관주화료술보조치료지체 STS 료효만의，능명현살멸종류조직、강저술후국부복발솔、개선환자적예후、부반응교소、안전성교고，대국부만기연조직종류적보지구유중요작용。
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±37.71 ) months. Complete response ( CR ) was achieved in 1 patient, and partial response ( PR ) in 5 patients. The overall response ( OR ) rate was 50%. There were 5 cases of metastases and 2 cases of local recurrences and amputation. The local recurrence ( LR ) rate was 16.66%, and the limb salvage ( LS ) rate was 83.34%. Contracture of Achilles tendon was noticed in 1 patient, who underwent Achilles tendon lengthening and recovered well. Muscular venous thrombosis was found in 1 patient, who was treated with thrombolytic therapy and got fully recovered. Toxicity of the procedure was mild ( Wieberdink I-III ), and there was no Wieberdink IV and Wieberdink V.Conclusions As a preoperative adjuvant therapy, the HILP chemotherapy is an effective method in the treatment of soft tissue sarcomas of the limbs. It can signiifcantly kill tumor cells, reduce the local recurrence rate and improve the prognoses of the patients, with less side effects and higher safety. It plays an important role in limb salvage for the patients with locally advanced soft tissue sarcomas.