局部刮除肿瘤联合放疗治疗骨巨细胞瘤的临床研究

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剐（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。

Clinical Study on the Local Curettage of Tumor Combined with Radiotherapy in the Treatment of Giant Cell Tumor of Bone

Objective： To explore the clinical efficacy and toxic reaction of Local curettage combined with conformal immobiliza- tion applicator model brachytherapy and postoperative irradiation in the treatment of giant cell tumor of bone （GCTB）. Methods： 30 treat- ment-naive Long Bone GCTB patients were collected from Hunan provincial tumor hospital from Feb 2006 to Feb 2008, and were divided randomly into two groups： Local curettage group and local curettage combined with radiotherapy group. An analysis was performed in clinical efficacy and toxic reaction of the two groups. Results： The re-recurrence rate in local curettage combined with radiotherapy group were 0%, 0%, 0% for the first year, the third year and the fifth year post-operation respectively, while were 9.1%,27.3%,45.5% respec- tively in local curettage group. The re-recurrence rate （P〈0.05） of the third year and the fifth year post-operation were significant higher in local curettage group. There were no severe treatment-related toxicity and death in local curettage combined with radiotherapy group. There was no difference in postoperative joint function score between two groups. Conclusion： Local curettage combined with radiother- apy for giant cell tumor of bone is a safe method orovides satisfied effect and has no effect on ioint function.