同步推量调强放疗制作肢体软组织肉瘤外科边界的临床研究

Clinical research on the making of surgical margin in limb soft tissue sarcomas by simultaneous integrated boost intensity modulated radiation therapy

目的探讨同步推量调强放射治疗(SIB-IMRT)技术制作肢体软组织肉瘤(soft tissue sareoma,STS)外科边界的临床疗效。方法应用SIB-IMRT技术对41例局部晚期肢体STS患者进行术前放疗。处方剂量:计划靶区(PTV)DT 42.0~45.0 Gy(15 f,3周),全程同步推量外科边界靶区(GTVs)DT 45.0~52.5 Gy(15 f,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,计算2年无复发生存率。结果 SIB-IMRT前、后患肢肢体周径分别为(53.17±17.81)cm和(50.62±18.14)cm,周径平均缩小(2.42±1.75)cm,差异有统计学意(P<0.05);SIB-IMRT后病灶缩小33例,反应率为80.49%(33/41),完全缓解(CR)0例;部分缓解(PR)18例,病灶稳定(SD)23例;随访7~55个月,伤口并发症发生率2.4%,2年无复发生存率为87.80%。4例肺转移,5例复发,其中肺转移合并复发2例。结论 SIB-IMRT制作局部晚期的肢体STS外科边界近期疗效显著,患者耐受性较好。

Objective To investigate the clinical effects of simultaneous integrated boost intensity modulated radiation therapy （ SIB-IMRT ） for making surgical margin in limb soft tissue sarcomas （ STS ）. Methods A total of 41 patients with locally advanced limb STS were treated by SIB-IMRT before the operation. The prescription dose included planning target volume （ PTV ） DT 42.0 - 45.0 Gy （ 15 f, 3 weeks ） and simultaneous integrated boost-gross tumor volumes （ 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. The limb circumference and tumor size were measured before and after SIB-IMRT, as well as the 2-year relapse-free survival. Results The limb circumferences were （ 53.17 ± 17.81 ） cm and （ 50.62 ± 18.14 ） cm before and after SIB-IMRT. The circumference was shrunk by （ 2.42 ± 1.75 ） cm on average, and the differences were statistically significant （ P 〈 0.05 ）. The SIB-IMRT response rate was 80.49% （ 33 / 41 ）, with volume shrinkage in 33 cases, complete remission （ CR ） in 0 case, partial remission （ PR ） in 18 cases and stable disease （ SD ） in 23 cases after SIB-IMRT. The follow-up lasted for 7 - 55 months. The wound complication rate was 2.4%, and the 2-year relapse-free survival was 87.80%. There were 4 cases of pulmonary metastases, 5 cases of recurrence and 2 cases of both. Conclusions The short-term effects of the SIB-IMRT technology for making surgical margin in locally advanced limb STS are definite, with good tolerance.