FUNCTIONAL AND PSYCHOSOCIAL EFFECTS OF MULTIMODALITY LIMB-SPARING THERAPY IN PATIENTS WITH SOFT-TISSUE SARCOMAS
FUNCTIONAL AND PSYCHOSOCIAL EFFECTS OF MULTIMODALITY LIMB-SPARING THERAPY IN PATIENTS WITH SOFT-TISSUE SARCOMAS
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DOI：
10.1200/jco.1989.7.9.1217
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发表时间：
1989-09-01
影响因子：
45.3
通讯作者：
ROSENBERG, SA
中科院分区：
文献类型：
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作者：
CHANG, AE;STEINBERG, SM;ROSENBERG, SA
我们记录了四肢软组织肉瘤患者在接受多模式保肢治疗后的功能和心理社会变化。88例患者在手术前和术后每6个月记录与经济状况、性活动、疼痛、肢体功能和总体生活质量(QOL)相关的参数。分析每一位患者的术前评估各参数的变化。术后6个月，在相当数量的患者中，就业状况、性活动和肢体功能都有所下降。在12个月时，这些下降仍然很明显。尽管发生了这些变化，但通过标准化测试衡量的全球生活质量显示，在12个月时，相当一部分患者至少有了一些改善。这些发现突显了定义生活质量的难度。由于每个亚组的患者人数较少，无法确定放射治疗和/或化疗是否是导致特定变化的因素。然而，在60名高度恶性肉瘤患者中，接受术后放射治疗联合阿霉素和环磷酰胺化疗的33名患者中，有10名出现了明显的伤口问题，而只接受辅助化疗的27名患者中有1名出现了明显的伤口问题(P=.016)。此外，在随访12个月的高级别肉瘤患者中，接受放射治疗和化疗的19名患者中有6名出现了关节痉挛，而只接受化疗的15名患者中这一数字为零(P<；0.04)。与单纯化疗相比，高级别肉瘤患者术后放疗和化疗的联合应用似乎明显增加了组织相关损伤。
We have documented functional and psychosocial changes in patients with extremity soft tissue sarcomas who have undergone multimodality limb-sparing treatments. In 88 patients, parameters related to economic status, sexual activity, pain, limb function, and global quality of life (QOL) were recorded prior to surgery and every 6 months postoperatively. Changes from the preoperative assessment for every parameter were analyzed in each patient. Six months after surgery, there was a decrease in employment status, sexual activity, and in limb function in a significant number of patients. At 12 months, these decreases were still evident. Despite these changes, global QOL measured by a standardized test showed at least some improvement in a significant proportion of patients at 12 months. These findings highlight the difficulty in defining QOL. It could not be ascertained if radiation therapy and/or chemotherapy were causative factors in specific changes because of the small numbers of patients in each subgroup. However, among 60 patients with high-grade sarcomas, significant wound problems developed in 10 of 33 who received postoperative radiation therapy in combination with adjuvant doxorubicin and cyclophosphamide chemotherapy compared with one of 27 patients who received adjuvant chemotherapy alone (P = .016). Also, among high-grade sarcoma patients with 12-month follow-up, six of 19 patients who received radiation therapy and chemotherapy developed joint contractures compared with zero of 15 patients who received chemotherapy alone (P < .04). The combination of postoperative radiation therapy and chemotherapy appeared to be associated with significantly more tissue-related injury in patients with high-grade sarcomas compared with chemotherapy alone.