肢体恶性骨与软组织肿瘤介入性新辅助化疗的应用

Role of interventional neoadjuvant chemotherapy for limb salvage in bone and soft tissue sarcoma

目的探讨术前动脉内灌注化疗对骨与软组织恶性肿瘤的近期疗效及在保肢治疗中的意义。方法21例四肢恶性骨与软组织肿瘤,其中骨肉瘤5例,尤文氏肉瘤1例,滑膜肉瘤2例,恶性纤维组织细胞瘤13例。术前均给予选择性肿瘤供血动脉灌注化疗2～3周期,化疗药物为阿霉素、顺铂和异环磷酰胺,骨肉瘤另加大剂量甲氨蝶呤静脉滴注。化疗后均行保肢手术治疗。结果21例术前化疗后疼痛均迅速缓解,皮温恢复正常,瘤体不同程度缩小、瘤体硬化、边缘清楚及有部分活动度,骨肉瘤化疗后AKP恢复正常。化疗后均行肿瘤广泛切除、人工关节置换或异体半关节移植术,术中获得良好的外科切除界限。结论术前动脉内灌注化疗对四肢骨与软组织恶性肿瘤的近期疗效满意,是一种能显著提高保肢率的有价值的新辅助化疗方法。

Objective To investigate the role oftranscatheter target arteries chemotherapy for malignant bone and soft tissue tumor. Methods Infusion chemotherapy transcatheter target arteries were performed for 21 bone and soft tissue malignant tumor cases before operation. 21 patients underwent limb salvage procedures after chemotherapy, R^sults The obvious pain relief was observed. The extent of tumor, confirmed with physical examination or CT/MRI, was smaller than before chemotherapy. Limb salvage procedures were performed in 21 patients after chemotherapy. Conclusions Interventional neoadjuvant chemotherapy was an effective and optional therapy for malignant bone and soft tissue tumor. However the long term effect needs further observation.