大功率微波热疗联合化疗和放疗治疗髋关节骨肉瘤

High power microwave hyperthermia combined with HD-MTX and radiotherapy for hip joint osteosarcoma

目的探索用大功率微波热疗结合大剂量甲氨喋呤(HD-MTX-CF)和放疗治疗髋关节骨肉瘤的新疗法。方法先以HD-MTX-CF为主,联合长春新碱(VCR)和阿霉素(ADM)化疗1～2周期,继用6Mv直线加速器对髋关节病灶照射,放疗剂量DT:7000～8000cGy,再以HD-MTX-CF为主巩固化疗2～3周期,结合UHR-915MHz大功率微波热疗机对病灶进行加热(化疗时结合热疗1～2次/周期;放疗时结合热疗1～2次/周),每次加热时间90～120min,温度40～42℃,热疗时对鼓膜、食管和直肠进行测温。结果12例患者,生存时间7个月至10年,中位生存时间25个月,局部控制率为100%,生存最长2例为无瘤生存。不良反应以白细胞下降、消化道反应及轻度药物性肝损害多见;药物性肝损害表现为ALT、AST增高,可于短期内恢复。结论大功率微波热疗结合大剂量甲氨喋呤和放疗治疗髋关节骨肉瘤疗效好,不良反应少,值得临床推广。

Objective To search for a new therapy i.e with high power microwave hyperthermia combined with HD-MTX and radiotherapy in treating hip joint osteosarcoma. Methods There were 12 male patients. Firstly,1-2courses of chemotherapy, HD-MTX-CF combined with VCR and ADM; Secondly, 6-My linear accelerator was used on hip joint focus; radiation dose was 7 000-8 000cGY. Then 2-3 courses of chemotherapy as the former. At the same time,the high power microwave hyperthermia with 915MHz on hip joint focus was combined （1 or 2 sessions hyperthermia along with chemotherapy a course; 1 or 2 sessions hyperthermia along with radiotherapy a week）. The temperature was keeped 40-42℃ for 90-120min per session. The temperature in tympanum, esophagus and rectum was detected in turn. Results The survival time was 7-10years. The median survival was 25monthes. The local control rate was 100%. Some adverse reactions were presented, such as leucopenia, alimentary tract reaction and mild liver damage. The liver damage means the rise of ALT and AST, but it resumed in short time. Conclusion High power microwave hyperthermia combined with HD-MTX and radiotherapy in treating hip joint osteosarcoma is safe and efficient.