儿童骨盆尤文肉瘤的治疗以及对骨骼生长发育的影响
Treatment of pelvic Ewing's sarcoma in children and the effect on the skeletal growth and development
付军 1郭征 2王臻 1栗向东 1李靖 1陈国景 1吴智钢1
作者信息
- 1. 710032西安,第四军医大学西京医院骨肿瘤科
- 2. 第四军医大学全军骨科研究所
- 折叠
摘要
目的 探讨以异环磷酰胺、阿霉素+顺铂的序贯化疗方案加肿瘤精确切除重建对儿童骨盆尤文肉瘤的治疗效果,并评估手术治疗对儿童骨骼生长发育的影响.方法 回顾性分析第四军医大学西京医院骨肿瘤科2001年1月至2010年10月收治的10例儿童骨盆尤文肉瘤患者的临床和随访资料,所有患者术前均采用新辅助化疗,行手术切除重建并辅以术后化放疗.化疗采用异环磷酰胺、阿霉素+顺铂方案.采用传统切除重建手术5例,采用计算机辅助进行肿瘤精确切除5例,骨盆重建时适当降低患侧髋关节旋转中心.结果 新辅助化疗后,完全缓解1例,部分缓解8例,稳定1例.手术后肢体功能评分为优4例,良好4例,一般1例,差1例.使用导航计算机技术辅助治疗的5例患者肿瘤切除完整,内固定位置准确,未出现局部复发.全组患者均无严重并发症的发生.平均随访37.8个月,10例患者全部生存,但有1例患者术后2年出现肺转移.全组有8例患者的骨骼生长发育未出现明显影响,有1例患者出现髋关节旋转中心失平衡,有1例患者出现代偿性脊柱侧弯.结论 以新辅助化疗、手术切除重建、术后化放疗联合治疗儿童骨盆尤文肉瘤的疗效较好;计算机导航辅助技术为儿童骨盆肿瘤的精确切除与重建提供了新的、有效的解决途径;儿童髋臼Y形软骨骺板可能是尤文肉瘤局部侵袭的天然屏障.
Abstract
Objective To explore the effect of neo-adjuvant chemotherapy and computer-assisted surgery on children and adolescents with primary pelvic Ewing's sarcoma,and assess the therapeutic effect on the pelvic skeletal growth and development.Methods This is a retrospective analysis of 10 children with primary pelvic Ewing's sarcoma treated between Jan 2001 and Oct 2010 at the Department of Oncologic Orthopaedics at Xijing Hospital.There were 3 girls and 7 boys in the age of 7 to 16 years (average 12.7 years).All patients were pathologically diagnosed as Ewing's sarcoma.There were two cases in the sacroiliac joint,one in the ilium,one in the pubic bone,and 6 cases in peri-acetabular area including 5 below the triradiate cartilage and one above the triradiate cartilage,without cartilage invasion.All patients underwent neo-adjuvant chemotherapy,resection and reconstruction surgery and postoperative chemotherapy.CDP,ADM and IFO regimen chemotherapy were given as the main treatment.Five cases were treated by traditional resection and reconstruction,and after 2008,five cases were treated by computer-assisted surgery.During the reconstruction,the hip rotation center was put at a depressed location.All of the 10 cases underwent postoperative radiotherapy in a dose of 45-55 Gy.Results All patients were followed-up for 12-72 months (mean:37.8 months).One child had tumor recurrence and lung metastasis and 9 patients had no evidence of disease (NED).After neo-adjuvant chemotherapy,the oncologic statuses (RECIST)were:1 CR,8 PR and 1 SD.The functional recoveries after surgery (Enneking's) were:4 cases excellent,4 good,1 fair and 1 poor.Five cases who underwent computer-assisted surgery achieved a good reconstruction without local recurrence.There were no effects on skeletal growth in 8 cases.An unbalanced hip rotational center occurred in one case,and a compemsatory scoliosis was found in another case.There were no serious complications in all patients.Conclusions The comprehensive treatment including neoadjuvant chemotherapy,resection-reconstruction surgery and postoperative chemoradiotherapy may give a good control to primary pelvic Ewing's sarcomas in children and adolescents.The computer-assisted surgery used for accurate tumor resection and pelvic reconstruction is a good alternative when treating young patients with malignant pelvic tumors.The triradiate cartilage in children's acetabulum could be a natural barrier resistant to the invasion of Ewing's sarcomas.
关键词
儿童/骨盆/尤文肉瘤/化学疗法/外科手术,计算机辅助Key words
Child/Pelvis/Ewing's sarcoma/Drug therapy/Surgery,computer-assisted引用本文复制引用
出版年
2012
NETL
NSTL
维普
万方数据