SIB-IMRT技术在局部晚期肢体软组织肉瘤外科边界的确定与疗效

SIB-IMRT technology for making locally advanced limb soft tissue sarcoma surgical margin and its curative effect

目的评价术前同步推量调强放射治疗（sIBIMRT）技术应用于四肢软组织肉瘤（STS）外科边界中的临床疗效。方法将SIB-IMRT技术应用于32例局部晚期肢体STs患者的外科边界中。处方剂量：计划靶区（PTV）DT42．0～45．0Gy（15f，3周）全程同步推量外科边界靶区（GTVs）DT45．0～52．5Gy（15f，3周），5～7野；放疗结束后3～6周手术。测量SIB-IMRT前、后肢体周径及肿瘤大小；根据CTCAE4．0标准评价急性放射性皮肤损伤情况。结果SIB-IMRT前、后患肢肢体周径分别为（52．84±18．84）、（50．53±18．56）cm，周径平均缩小（2．31±1．98）cm，差异有统计学意义（P〈0．05）；SI／3-IMRT反应率为81．3％（26／32），SIB-IMRT后部分缓解（PR）14例，病灶稳定（SD）18例；随访12～36个月，4例肺转移，5例死亡，4例复发，无复发中位生存时间为15个月；急性放射性皮肤损伤1级26例，2级4例，3级2例。结论SIB-IMRT技术应用于局部晚期的四肢STS外科边界近期疗效确切，可缩短放疗疗程，患者耐受性较好。

Objective To evaluate the clinical effect of simultaneous integrated boost intensity modulated radiation therapy （SIB-IMRT） for making limb soft tissue sarcoma（STS） surgical margin. Methods Totally 32 patients with locally advanced limb soft tissue sarcoma were performed surgical margin making the by SIB-IMRT. The prescription dose：PTV DT 42.0-45.0 Gy（15 f,3 weeks） ,SIB-GTVs DT 45.0-52.5 Gy（15 f,3 weeks） ,5-7 fields;the operation was performed at 3-6 weeks after SIB-IMRT. To measure the limb circumference and tumor size; to evaluate the acute radioactive skin damage by CTCAE 4.0. Results The limb circumferences were （52.84±18.84）cm and （50. 53 ± 18. 56）cm before and after SIB-IMRT, the circumference was averagely shrunk by （2.31±1.98）cm, the difference was statistically significant（P〈0.05）;the SIB-IMRT response rate was 81. 3% （26/ 32）, the partial remission （PR） was in 14 cases and stable disease（SD） was in 18 cases after SIB-IMRT;follow up lasted for 15-36 months,4 cases had pulmonary metastasis, 5 cases died and 4 cases had recurrence, the relapse-free median survival time was 15 months ;acute radioactive skin damage was grade 1 in 26 cases, grade 2 in 4 cases and grade 3 in 2 cases, Conclusion The short time effect of the SIB-IMRT technology for making locally advanced limb STS surgical margin is definite, can shorten the radiotherapeutic course with good patient＇s tolerance.