同期小野补量放疗肢体软组织肉瘤的临床研究

Simultaneous small-field boosting radiotherapy for soft tissue sarcoma in the extremities

目的 探讨同期小野补量放疗技术在肢体软组织肉瘤治疗中的作用及疗效。方法 86例肢体软组织肉瘤术后患者随机分为研究组4 5例和对照组4 1例。研究组大野4 5～5 0Gy/4.5～5 .0周,小野2 0～30Gy/3～4周,每天2个野轮照,间隔6h以上;对照组大野4 5～5 0Gy/4.5～5 .0周后缩野加量2 0～30Gy/2～3周。结果 研究组和对照组1、3、5年生存率分别为90 .6 %和85 .4 %、86 .7%和72 .9%、73.3%和6 5 .0 % (P >0 .0 5 ) ;1、3、5年局部复发率分别为4 .4 %和9.8%、8.9%和2 6 .8%、13.3%和32 .6 % (P <0 .0 5 )。研究组和对照组急、慢性放射性皮肤损伤、慢性放射性皮下组织损伤发生率分别为6 0 .0 %和4 1.5 %、80 .0 %和6 3.4 %、77.8%和6 5 .9% (P >0 .0 5 )。结论 同期小野补量照射技术不增加放射性损伤,但能明显降低局部复发率、提高生存率。

Objective To evaluate the effect and the role of simultaneous small -field boosting radiotherapy for limb soft tissue sarcoma. Meth ods Eighty-six p atients with limb soft tissue sarcoma were randomized into two groups: study gro up (45 patients) received simultameous small-field boosting radiotherapy and co n trol group (41 patients) received routine radiotherapy. Radiatherapy in the stud y group was: larger field 45-50?Gy/4.5-5.0 weeks combined with small field 2 0-30 ?Gy/3-4 weeks, with 2 fields irradiated alternately every day with an interva l o f >6 hours. Radiotherapy in the control group was: 45-50?Gy/4.5-5.0 weeks fol lo wed by small field boost 20-30?Gy/2-3 weeks. Results The 1-, 2- and 3-yea r surv ival rates were 90.6%, 86.7% and 72.9% in the study guoup and 85.4%, 73.3% and 6 5.0% in the control group (P >0.05). The corresponding 1-, 2- and 3-year loca l r ecurrence rates were 4.4%, 8.9%, 13.3% and 9.8%, 26.8%, 32.6% (P <0.05). Acute an d chronic skin toxicity and chronic soft tisse toxicity were 60.0%, 80.0% , 77.8 % in the study guoup and 41.5%, 63.4%, 65.9% in the control group (P >0.05). Conclusions Simultaneous small-field boosting radiotherapy can obviously reduce t he local recurrence and improve the survival without causing more toxicities in the treatment of soft tissue sarcoma in extremities.