重要神经血管周围肉瘤手术联合后装放疗效果分析

张超; 王国文; 韩秀鑫; 滕胜; 马育林; 陈忠杰; 孙武军

doi:10.3971/j.issn.1000-8578.2019.18.1685

重要神经血管周围肉瘤手术联合后装放疗效果分析

Effect of Surgical Excision Combined with Brachytherapy Treatment on Sarcoma Surrounding Important Nerve and Blood Vessels

摘要

摘要:
目的分析重要神经血管周围肉瘤手术切除联合后装治疗的有效性及安全性。
方法回顾性分析2015年3月—2017年4月病理明确为重要神经血管周围肉瘤患者30例，行手术切除并神经血管周围置后装管，术后给予后装治疗，分次剂量为4 Gy，放疗总剂量为40 Gy，每日2次，5天完成后装放疗。并对所有患者肢体功能治疗前、治疗后6月进行MSTS功能评分。
结果患者随访时间为18~43月，平均随访时间为31.6月，中位随访时间为32.0月，2年生存率为96.7%。外科切缘R0 18例（60%），R1 12例（40%），患者术前MSTS评分为（23.36±1.51），术后6月评分为（21.51±1.82），差异无统计学意义（P＞0.05）。肿瘤局部控制率为93.3%，死亡病例1例，手术切口局部延迟愈合1例，二级及以上放疗并发症发生率为16.7%。
结论重要神经血管周围肉瘤手术切除联合后装治疗能够取得较高的局部控制率，保留肢体并对患者的肢体功能影响较小，但需积极防控后装治疗相关并发症。

Abstract:
Objective To analyze the efficacy and safety of surgical excision combined with brachytherapy treatment on sarcoma surrounding important nerve and blood vessels.
Methods We retrospectively analyzed 30 patients pathologically diagnosed as sarcoma which was adjacent to the important nerve and blood vessels from March 2015 to April 2017. Extensive resection was performed. All patients received brachytherapy 2-3 days after operation. The fractional dose was 4Gy. The total dose of radiotherapy was 40Gy, twice a day. Brachytherapy took 5 days. All patients were assessed with MSTS function before surgery and 6 months after treatment.
Results The follow-up time was 18-43 months, with an average of 31.6 months. The median follow-up time was 32.0 months. The 2-year survival rate was 96.7%, 18 cases(60%) of surgical margin R0 and 12 cases(40%) of R1. The MSTS score was 23.36±1.51 before operation and 21.51±1.82 six months after operation(P > 0.05). The local control rate of tumors was 93.3%. One patient died and one patient had nonunion incision. The incidence of ≥ grade 2 radiotherapy complications was 16.7%.
Conclusion Surgical excision combined with brachytherapy treatment on sarcoma surrounding important nerve and blood vessels could achieve high local control rate, preserve limbs and have little influence on limb function of patients, but it is necessary to actively prevent and control the complications associated with brachytherapy.

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