二例骨肉瘤患者术中放射治疗原位灭活保肢治疗的长期随访报告

Long-term effects of radiotherapy in situ for limb salvage in patients with osteosarcoma

目的肢体骨肉瘤的手术方式主要以保肢手术为主。在瘤骨的原位灭活中,有多种方式,其中术中电子线放疗是一种手术操作简便,术后并发症较少的方法。笔者针对3例肢体骨肉瘤术中行电子线放射,肿瘤切刮内固定的保肢手术患者的疗效分析,评价这种方式的临床效果及相关优缺点。方法选取2003年5月至2006年4月之间3例手术患者病例资料,比较患者一般情况,手术方式、术中电子线照射方式及剂量、术后患者恢复情况及术后肢体功能等方面,分析评估骨肉瘤行术中电子线放射,肿瘤切刮内固定的保肢手术后的临床疗效。结果 1例术后生存8个月后因病情进展出现肿瘤肺转移死亡。1例术后5个月后出现接骨板断裂,行二次手术治疗后痊愈,目前无瘤生存并已随访12年。1例因术后局部出现骨坏死5年后行二次手术治疗,目前无瘤生存并已随访12年。术中放射的优点有:原位灭活肿瘤组织,保存正常的关节连接,早期骨骼强度影响小,利于肢体功能的康复,又可以简化手术方法。缺点有:术中放疗由于属瘤内手术,要求到加速器机房手术,对设备的要求高,手术时间长。结论术中放疗可以在原位灭活肿瘤组织,又不即刻降低瘤骨的生物学性能,使术后肢体与关节功能不受大的影响。因此,术中放疗适合于骨肉瘤的生物保肢治疗。

Objective Limb salvage surgery is a main treatment method for limb osteosarcom. There are many ways to choose tumor inactivation in situ. Intraoperative electron beam radiotherapy is a simple way with less postoperative complications. We evaluated the clinical effects of this approach by analyzing 3 cases of limb osteosarcom. Methods The data of 3 cases from May 2003 to April 2006 were selected. The general information, operation approach, mode and dose of intraoperative electron beam irradiation, postoperative recovery and postoperative limb functions were compared. Results of limb salvage surgery（ electron beam irradiation, tumor resection, internal fixation） were evaluated. Results One patient died of lung metastasis 8 months after the surgery. One patient had plate fracture 5 months postoperatively and underwent second operation, who was tumor-free and followed up for 12 years. One patient underwent second surgery 5 years postoperatively due to the post-operative osteonecrosis, who was tumor-free and followed up for 12 years. Advantages of intraoperative radiotherapy： local inactivation, preserved normal articulation, less invasive, faster rehabilitation, simplified approach. Disadvantages： high costs of equipment and long operation time. Conclusions Intraoperative radiotherapy can inactivate tumor tissues in situ, without immediate reduction of biological properties of the tumor bone. Postoperative limb and joint functions are not easily affected. Therefore, intraoperative radiotherapy is suitable for biological limb salvage in the treatment of osteosarcoma.