目的探讨125I粒子组织间永久植入在腹膜后肉瘤切除术中的应用和疗效。方法回顾性分析了2003年5月—2006年12月7例腹膜后肉瘤切除联合术中在瘤床、肿瘤残存灶内植入125I粒子,每颗粒子活度0.5~0.6 mC i,共植入125I粒子259颗,平均37颗。结...目的探讨125I粒子组织间永久植入在腹膜后肉瘤切除术中的应用和疗效。方法回顾性分析了2003年5月—2006年12月7例腹膜后肉瘤切除联合术中在瘤床、肿瘤残存灶内植入125I粒子,每颗粒子活度0.5~0.6 mC i,共植入125I粒子259颗,平均37颗。结果7例患者均顺利完成手术,术后未发生出血、感染、胃肠道穿孔、大血管穿孔、粒子移位等并发症。随访4~25个月,7例均存活。结论腹膜后肉瘤切除联合术中125I粒子组织间永久植入治疗,使手术、放疗同步进行,可明显提高疗效,安全、易操作,是肿瘤综合治疗的有效手段之一。展开更多
目的构建精准化、个体化评价腹膜后肉瘤(retroperitoneal sarcoma,RS)患者预后的模型,为临床决策制定提供参考。方法提取监测、流行病学及结局(Surveillance,Epidemiology and End Results,SEER)数据库2000~2019年经病理学确诊的RS患者...目的构建精准化、个体化评价腹膜后肉瘤(retroperitoneal sarcoma,RS)患者预后的模型,为临床决策制定提供参考。方法提取监测、流行病学及结局(Surveillance,Epidemiology and End Results,SEER)数据库2000~2019年经病理学确诊的RS患者临床资料,以7∶3的比例随机划分为训练集和验证集,采用多因素Cox比例风险模型、LASSO回归模型和随机生存森林模型筛选变量,构建预测1、3年肿瘤特异性生存期(cancer-specific survival,CSS)和总生存期(overall survival,OS)的诺谟图模型,利用一致性指数、受试者工作特征曲线评估其预测价值,并用校正曲线对诺谟图预测模型进行内部(训练集)与外部(验证集)验证。结果共纳入2559例患者,其中训练集1791例,验证集768例。多因素Cox比例风险模型显示,年龄、肿瘤分期、肿瘤分级、手术方式和化疗是OS的独立影响因素,而年龄、病理类型、肿瘤分级、肿瘤分期、手术方式和化疗是CSS的独立影响因素。LASSO回归模型显示,年龄、性别、病理类型、肿瘤分级、肿瘤分期、手术方式和化疗患者OS相关,而年龄、病理类型、肿瘤分级、肿瘤分期、手术方式和化疗与患者CSS相关。随机生存森林模型显示,影响OS的重要性评分前5位变量分别为肿瘤分级、手术方式、年龄、肿瘤分期和化疗,而影响CSS的重要性评分前5位变量分别为肿瘤分级、手术方式、肿瘤分期、化疗和年龄。基于上述因素所构建的诺谟图验证结果表明,OS在训练集和验证集的一致性指数分别为0.746(95%CI=0.730~0.760)和0.729(95%CI=0.710~0.750),而CSS分别为0.770(95%CI=0.750~0.790)和0.743(95%CI=0.720~0.770),校准曲线表现出良好的一致性。结论年龄、性别、肿瘤分级、肿瘤分期、手术和化疗是RS患者预后的独立影响因素。本研究构建的诺谟图预测模型具有良好的预测价值,有利于临床对RS患者选择个性化治疗。展开更多
The combination of radiotherapy(RT) and function-preserving surgery is the most usual contemporary approach in the management of soft tissue sarcomas(STS). Pre- and postoperative RT result in similar local control rat...The combination of radiotherapy(RT) and function-preserving surgery is the most usual contemporary approach in the management of soft tissue sarcomas(STS). Pre- and postoperative RT result in similar local control rates, as shown by a landmark trial in extremity STS. In this review, the role of RT in the management of extremity STS will be discussed, but STS in other sites,including retroperitoneal STS, will also be addressed. The focus will consider various aspects of RT including strategies to reduce the volume of tissue being irradiated, dose, scheduling, and the possible of omission of RT in selected cases. Finally, technology advances through the use of intensity-modulated radiotherapy(IMRT), image-guided IMRT, intraoperative radiotherapy(IORT)and particle therapy will also be discussed.展开更多
Background: Due to the limited number of clinical series and the lack of multi-institutional or national registries concerning retroperitoneal sarcoma (RPS) extending to major arterio-venous structures, the short and ...Background: Due to the limited number of clinical series and the lack of multi-institutional or national registries concerning retroperitoneal sarcoma (RPS) extending to major arterio-venous structures, the short and long-term benefits following concomitant resection of these major structures are still antagonistic. Objective: To present our institutional experience with RPS tumors, to assess their vascular involvement and to analyze the outcomes of onco-vascular approach. Patients and methods: A retrospective review of our institutional RPS patients’ clinical charts was performed. All consecutive adult patients surgically treated for RPS were included. Resection of RPS tumors was followed by histopathological examination for grading. Types of vascular involvement were assessed preoperatively. RPS tumors were resected en bloc together with blood vessels according to the type of vascular involvement and the surgical standards. Results: This study included 14 patients;8 males (57%) and 6 females (43%) with RPS. Vascular resection was performed in all patients. Adherent structures were resected in 43%. Resection was performed for 29% RPSs with arterial venous involvement, 14% with only arterial involvement, and 57% with only venous involvement. All RPSs were classified as high-grade lesions, and 64% showed secondarily major vessels involvement. 43% of patients were treated by arterial resection. 80% had venous involvement. Venous resections were followed by venous reconstruction in all patients with both arterial and venous involvement. The morbidity rate was 43% while the mortality rate was 7%. Conclusion: Complete resection with clear margins is important for long-term survival in patients with retroperitoneal soft tissue sarcomas.展开更多
文摘目的探讨125I粒子组织间永久植入在腹膜后肉瘤切除术中的应用和疗效。方法回顾性分析了2003年5月—2006年12月7例腹膜后肉瘤切除联合术中在瘤床、肿瘤残存灶内植入125I粒子,每颗粒子活度0.5~0.6 mC i,共植入125I粒子259颗,平均37颗。结果7例患者均顺利完成手术,术后未发生出血、感染、胃肠道穿孔、大血管穿孔、粒子移位等并发症。随访4~25个月,7例均存活。结论腹膜后肉瘤切除联合术中125I粒子组织间永久植入治疗,使手术、放疗同步进行,可明显提高疗效,安全、易操作,是肿瘤综合治疗的有效手段之一。
文摘目的构建精准化、个体化评价腹膜后肉瘤(retroperitoneal sarcoma,RS)患者预后的模型,为临床决策制定提供参考。方法提取监测、流行病学及结局(Surveillance,Epidemiology and End Results,SEER)数据库2000~2019年经病理学确诊的RS患者临床资料,以7∶3的比例随机划分为训练集和验证集,采用多因素Cox比例风险模型、LASSO回归模型和随机生存森林模型筛选变量,构建预测1、3年肿瘤特异性生存期(cancer-specific survival,CSS)和总生存期(overall survival,OS)的诺谟图模型,利用一致性指数、受试者工作特征曲线评估其预测价值,并用校正曲线对诺谟图预测模型进行内部(训练集)与外部(验证集)验证。结果共纳入2559例患者,其中训练集1791例,验证集768例。多因素Cox比例风险模型显示,年龄、肿瘤分期、肿瘤分级、手术方式和化疗是OS的独立影响因素,而年龄、病理类型、肿瘤分级、肿瘤分期、手术方式和化疗是CSS的独立影响因素。LASSO回归模型显示,年龄、性别、病理类型、肿瘤分级、肿瘤分期、手术方式和化疗患者OS相关,而年龄、病理类型、肿瘤分级、肿瘤分期、手术方式和化疗与患者CSS相关。随机生存森林模型显示,影响OS的重要性评分前5位变量分别为肿瘤分级、手术方式、年龄、肿瘤分期和化疗,而影响CSS的重要性评分前5位变量分别为肿瘤分级、手术方式、肿瘤分期、化疗和年龄。基于上述因素所构建的诺谟图验证结果表明,OS在训练集和验证集的一致性指数分别为0.746(95%CI=0.730~0.760)和0.729(95%CI=0.710~0.750),而CSS分别为0.770(95%CI=0.750~0.790)和0.743(95%CI=0.720~0.770),校准曲线表现出良好的一致性。结论年龄、性别、肿瘤分级、肿瘤分期、手术和化疗是RS患者预后的独立影响因素。本研究构建的诺谟图预测模型具有良好的预测价值,有利于临床对RS患者选择个性化治疗。
文摘The combination of radiotherapy(RT) and function-preserving surgery is the most usual contemporary approach in the management of soft tissue sarcomas(STS). Pre- and postoperative RT result in similar local control rates, as shown by a landmark trial in extremity STS. In this review, the role of RT in the management of extremity STS will be discussed, but STS in other sites,including retroperitoneal STS, will also be addressed. The focus will consider various aspects of RT including strategies to reduce the volume of tissue being irradiated, dose, scheduling, and the possible of omission of RT in selected cases. Finally, technology advances through the use of intensity-modulated radiotherapy(IMRT), image-guided IMRT, intraoperative radiotherapy(IORT)and particle therapy will also be discussed.
文摘Background: Due to the limited number of clinical series and the lack of multi-institutional or national registries concerning retroperitoneal sarcoma (RPS) extending to major arterio-venous structures, the short and long-term benefits following concomitant resection of these major structures are still antagonistic. Objective: To present our institutional experience with RPS tumors, to assess their vascular involvement and to analyze the outcomes of onco-vascular approach. Patients and methods: A retrospective review of our institutional RPS patients’ clinical charts was performed. All consecutive adult patients surgically treated for RPS were included. Resection of RPS tumors was followed by histopathological examination for grading. Types of vascular involvement were assessed preoperatively. RPS tumors were resected en bloc together with blood vessels according to the type of vascular involvement and the surgical standards. Results: This study included 14 patients;8 males (57%) and 6 females (43%) with RPS. Vascular resection was performed in all patients. Adherent structures were resected in 43%. Resection was performed for 29% RPSs with arterial venous involvement, 14% with only arterial involvement, and 57% with only venous involvement. All RPSs were classified as high-grade lesions, and 64% showed secondarily major vessels involvement. 43% of patients were treated by arterial resection. 80% had venous involvement. Venous resections were followed by venous reconstruction in all patients with both arterial and venous involvement. The morbidity rate was 43% while the mortality rate was 7%. Conclusion: Complete resection with clear margins is important for long-term survival in patients with retroperitoneal soft tissue sarcomas.
