康静波 聂青 张丽萍 李启亮 王仁秋 李建国 齐文杰

 海军总医院 放疗科 北京  100037

摘要  目的：分析体部伽玛刀配合热疗及增敏剂治疗复发性软组织肉瘤的治疗效果。方法：自2004年2月至2007年2月收治软组织肉瘤56例。均为术后残存、复发或和转移，其中盆腔或盆壁术后复发21例，胸壁术后复发15例，腹膜后或腹腔术后复发6例，术后转移14例。采用立体定向体部伽玛射线放射治疗系统（体部伽玛刀）治疗，处方等剂量线采用55%～70%等剂量线包绕计划靶区；单次剂量4～6Gy/次，治疗次数为10～13次，总放射剂量45～56Gy。所有病人均给与放射增敏剂治疗，增敏剂使用注射用甘氨双唑钠，每次1.00～1.50g静脉滴注，隔日1次，伽玛刀治疗前0～3小时给药，共5-6次。31例病人配合热疗，自伽玛刀治疗后开始，每次1h，每周2次，共6次，每次热疗在伽玛刀治疗后4h内进行。结果：治疗后３个月总的有效率为８2.1％（46／56）；伽玛刀配合增敏组的1年、2年局部控制率分别为76.0%（19/25）、68.0%（17/25），1年、2年生存率分别为84.0%、72.0%；伽玛刀配合增敏及热疗组的1年、2年局部控制率分别为80.6%（25/31）、71.0%（22/31），1年、2年生存率分别为87.1%、77.4%；随访期内未见严重放射性并发症。结论：对复发性软组织肉瘤采用伽玛刀配合热疗及增敏剂进行治疗是较有效的局部治疗方式。

关键词：体部伽玛刀；软组织肉瘤；热疗；甘氨双唑钠;放射增敏剂

中图分类号：R730.55;R738.6

The clinical study of  body γ-knife with　 sensitizer and/or hyperthermia

For the recurrence of  soft tissue sarcoma.

           Kang Jingbo， Nie Qing , zhang liping ,et al. 

　　　　　　 Navy General  Hospital ( Beijing  100037 )

 Abstract:  Objective:   To study  the clinical  effect of the recurrence of soft tissue sarcoma that   was  treated  by   body γ-knife with　 sensitizer and/or hyperthermia.  Methods: From on February 2004 to on February 2007,56 patients recurrence with  soft tissue sarcoma were treated by  body γ-knife with　 sensitizer and/or hyperthermia, among which, the recurrence of 21 patients were in the pelvic cavity or pelvic wall, that  of 15 patients were in the chest wall, that of 6 patients were in the retroperitoneal space or abdominal cavity, were delivered 4Gy～6Gy/fraction(8～13fractions) for the  patients ,the total doses were 45Gy～56Gy. 55～70% isodose include 95% PTV .The radiosensitizer (glycodidazolum natrium)  were delivered  for all patients　among 0～３ｈbefore body γ-knife treatment, glycodidazolum natrium(CMNa) 1.00～1.50g V.D ,qod , 5～6 fraction .The hyperthermia for 31 patients were delivered during the treatment of body γ-knife ,2 fraction/week,total 6  fractions   Results : The total effective rate  was  of three months after treatment was ８2.1％（46／56）.  The control rates at 1、2 years was76.0%（19/25）、68.0%（17/25） ，The survival rate at 1、2 years was 84.0%、72.0%　respectively body γ-knife with　 radiosensitize.The control rates at 1、2 years was 80.6%（25/31）、71.0%（22/31） ，The survival rate at 1、2 years was87.1%、77.4% respectively body γ-knife with　 radiosensitize and hyperthermia.The serious complications of radiotherapy were not seen.     Conclusion:  Body γ-knife  is useful for the soft tissue sarcoma .

Key words:   body γ-knife, soft tissue sarcoma，hyperthermia,

　　　　　　　glycodidazolum natrium(CMNa)　 radiosensitizer