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目的:探讨局部刮除肿瘤联合术中适形固定施源器模型插植放疗和术后外照射治疗骨巨细胞瘤(GCTB)的临床疗效和毒副反应。方法:将2006年2月-2008年2月在湖南省肿瘤医院初次治疗的长骨GCTB患者30例随机分为单纯局部刮除手术组和局部刮除手术联合放疗组,两组患者均行局部肿瘤刮除术,局部刮除手术联合放疗组在此基础上给予术中适形固定施源器模型插植放疗和术后外照射,治疗后比较两组的临床疗效和毒副反应。结果:局部刮除手术联合放疗组1、3、5年均未复发,而单纯局部刮除手术组的1、3、5年复发率分别为9.1%、27.3%、45.5%,3年和5年复发率均显著高于局部刮除手术联合放疗组(P<0.05)。局部刮除手术联合放疗组中未见严重相关性毒性和死亡,术后两组的关节功能评分比较无明显差别(P>0.05)。结论:局部手术刮除病灶结合术中和术后放疗治疗骨巨细胞瘤可显著降低患者的复发率,且不影响关节功能,是一种较为安全的治疗方法。
Objective: To investigate the clinical curative effect and toxicity of GCTB in local curettage combined with intraoperative conformal fixation of source model and external beam radiotherapy. Methods: Thirty patients with long bone GCTB treated in Hunan Cancer Hospital from February 2006 to February 2008 were randomly divided into simple local curettage group and local curettage combined with radiotherapy group. All patients underwent local tumor Curettage, local curettage combined with radiotherapy group on the basis of intraoperative conformal fixation of the source device implantation radiation therapy and postoperative external irradiation after treatment, the clinical efficacy and toxicity were compared between the two groups. Results: The local curettage and radiotherapy group had no recurrence at 1, 3 and 5 years, while the recurrence rates at 1, 3 and 5 years in the local curettage group were 9.1%, 27.3%, 45.5%, 3 and 5 years respectively Year recurrence rate were significantly higher than the local curettage radiotherapy group (P <0.05). There was no serious relapse toxicity and death in the local curettage combined with radiotherapy group. There was no significant difference in the joint function score between the two groups after operation (P> 0.05). Conclusion: The local operation curettage lesion combined with intraoperative and postoperative radiotherapy for giant cell tumor of bone can significantly reduce the recurrence rate of patients, and does not affect the joint function, is a safer treatment.