Management of tumor adherent to the vertebral column.
Management of tumor adherent to the vertebral column.
复制标题
治疗附着在脊柱上的肿瘤。
DOI：
10.1016/s0022-5223(19)34574-x
复制
发表时间：
1989
期刊：
影响因子：
--
通讯作者：
S. Montner
中科院分区：
文献类型：
--
作者：
T. Demeester;M. Albertucci;P. Dawson;S. Montner
12 名非小细胞肺癌患者的肿瘤粘附在脊柱上，临床上怀疑侵犯骨。通过治疗前纵隔镜检查评估，所有患者均未出现纵隔淋巴结受累。所有患者均接受了 3000 拉德的术前放射治疗，随后对肺部和受累椎体的切向部分进行了整体切除。还进行了完整的纵隔淋巴结切除术。 3 名患者患有真正的 Pancoast 综合征，其余 9 名患者的肿瘤位于 T6 以上，大部分位于胸尖。可切除性取决于肿瘤是否延伸至肋横孔以及椎体受累的程度。对脱钙手术标本的详细研究表明，两名患者的肿瘤延伸至皮质，六名患者的肿瘤延伸至骨膜，三名患者的肿瘤延伸至壁层，一名患者的肿瘤延伸至脏层胸膜。 6 名患者在 1 至 11 年后仍存活（其中 4 名患者超过 5 年），没有复发肿瘤和关节炎疼痛的证据。总体 5 年和 10 年生存率（Kaplan-Meier 法）为 42%。对于肿瘤粘附在椎体上且无X线侵蚀证据的患者，需要整块切除肺和受累椎体部分才能完全切除，这与长期生存且无后遗症有关。
Twelve patients with non-small cell lung cancer had tumors that were adherent to the vertebral column and clinically suspected of invading the bone. All were free of mediastinal node involvement as assessed by pretreatment mediastinoscopy. All received 3000 rads of preoperative radiation followed by en bloc resection of the lung and a tangential portion of the involved vertebral bodies. A complete mediastinal lymphadenectomy was also performed. Three patients had true Pancoast’s syndrome and in the remaining nine the tumor was located above T6 with the majority in the apex of the chest. Resectability was based on the absence of tumor extension into the costotransverse foramen and the extent of vertebral body involvement. Detailed studies of the decalcified surgical specimen show that the tumor extended into the cortex in two patients, periosteum in six, parietal in three, and up to the visceral pleura in one. Six patients are alive after 1 to 11 years (four beyond 5 years) without evidence of recurrent tumor and arthritic pain. The overall 5- and 10-year survival rate (Kaplan-Meier method) was 42%. In patients with tumors adherent to the vertebral body and no evidence of roentgenographic erosion, the en bloc removal of the lung and the involved portion of the vertebral body is required for complete excision and is associated with long-term survival without sequelae.