Limb Salvage Treatment of Pediatric Ewing's Sarcoma in the Femur Shaft via Neoadjuvant Chemotherapy Combined with Vascularized Fibular Graft
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摘要:
目的 探讨新辅助化疗结合带血管蒂腓骨移植保肢治疗儿童股骨干尤文肉瘤的疗效。 方法 采用新辅助化疗结合带血管蒂腓骨移植保肢治疗儿童股骨干尤文肉瘤20例，按Enneking分期分为ⅡA期5例，ⅡB期15例。均进行术前化疗、保肢手术和术后化疗。所有切除标本均行病理切片的坏死率评估以调整术后化疗方案。 结果 全组患儿均获随访，随访时间6~45个月，平均30个月。随访至2011年8月30日，17例无局部复发或远处转移。1例术后1年内出现骨盆部转移并肺栓塞死亡，2例术后2年内出现肺部转移，并因肺转移合并呼吸循环衰竭死亡。3年无瘤生存率85%，最终保肢率100%。移植腓骨与股骨连接处术后8~12周内骨性愈合。术后按Enneking评分标准评定疗效优20例。 结论 新辅助化疗结合带血管蒂腓骨移植保肢治疗是儿童股骨干尤文肉瘤一种有效的治疗方法。 Abstract:Objective To explore the clinical effect of limb salvage treatment on pediatric Ewing's sarcoma in the femur shaft via neoadjuvant chemotherapy and vascularized fibular graft. Methods Twenty patients with pediatric Ewing's sarcoma in the femur shaft were classified into Stage A or B according to Enneking classification. The patients were treated via preoperative neoadjuvant chemotherapy, limb salvage surgery, and postoperative neoadjuvant chemotherapy. The postoperative chemotherapy was adjusted according to the tumor necrosis rate after surgery. Results All patients were followed up for 6 months to 45 months (mean of 30 months). Seventeen out of the 20 patients survived without recurrence or distant metastasis until August 30, 2011. One patient developed pelvis metastasis and died of pulmonary embolism one year after surgery, and two patients died of pulmonary metastasis two years after surgery. The 3-year disease-free-survival rate was 85%. All patients were treated via limb salvage. The union between the fibula and the femur shaft was achieved within 8 weeks to 12 weeks after surgery. The results were evaluated using the Enneking evaluation system, which detected effective treatment in 20 patients. Conclusion Neoadjuvant chemotherapy combined with vascularized fibular graft is one of the effective methods for the treatment of pediatric Ewing's sarcoma in the femur shaft. -
Key words:
- Neoadjuvant chemotherapy /
- Fibular graft /
- Limb salvage /
- Ewing's sarcoma
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图 1 术前患肢X线
A：术前左股骨干正位X线片示左股骨干溶骨性骨破坏，骨膜反应呈板层状或“葱皮状” 现象；B：术前右股骨干正侧位X线片示右股骨干浸润性溶骨性骨破坏，肿瘤向软组织内 浸润
Figure 1. The X-ray examination before surgery
图 2 术后患肢X线
A：左股骨干尤文肉瘤瘤段切除后植入带血管蒂腓骨并用钛质接骨板固定重建股骨干；B：右股骨干尤文肉瘤瘤段切除后植入带血管蒂腓骨并用外固定支架固定重建股骨干
Figure 2. The X-ray examination after surgery
图 3 移植腓骨与股骨残端术后8~ 12周内达到骨性愈合
Figure 3. The view of the union between the fibula and the shaft of the femur within 8~12 weeks after surgery
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