瘤段切除结合内照射治疗恶性骨肿瘤临床分析

Clinical Analysis of HDR Interstitial Brachytherapy with Iridium-192 Afterloading with Cancer Segment Resection for Bone Carcinoma

目的 观察高剂量率骨内插植内照射治疗骨肿瘤的保肢效果。方法 8例恶性骨肿瘤均在术中置管进行内照射，每次治疗10Gy,2次/周，共6次，总剂量60Gy。治疗后2周有5例行瘤段切除术。结果 所有病人都能耐受治疗，瘤段切除标本见瘤段区均有广泛坏死、出血、死骨残存及组织退变，肿瘤的边缘3-6Gy照射区发现有少量退变不明显的瘤细胞存在，生存1年和3年分别有7例和5例。结论 高剂量率骨内插植内照射结合瘤段切除治疗骨肿瘤是可行的。

Objective To evaluate the effects on the patients of bone carcinoma treated by high dose rate （HDR） interstitial braehytherapy with Iridium-192 afterloading. Methods Eight cases of bone cancer （ carcinoma and sarcoma） were treated with microselection of the bone segment. The selection of a reference point depended on the invasion of the turnout. The dosage of 10Gy per fraction and two fractions per week formed the basis of our protocol, up to a total of 60Gy. Results All eight cases were followed up for five years, during which one, three and five years＇survival rates were as follows： 87.5% （7/8） , 62.5% （5/8）and 0% （0/8） %. Local and systemic side effects were not significant, The histological examination after irradiation showed the absence of tumour cells in five cases. In two cases, small quantity of degenerated tumour cells were found in the area irradiated with 3 -6Gy. Conclusion It is concluded that local brachytherapy in the treatment of bone malignancy may improve the results of treatment and the quality of life.