Diagnosis and surgical management of locally recurrent soft-tissue sarcomas of the extremity.
Diagnosis and surgical management of locally recurrent soft-tissue sarcomas of the extremity.
复制标题
四肢局部复发性软组织肉瘤的诊断和手术治疗。
作者：
E. Sauter;J. Hoffman;B. Eisenberg
有肢体软组织肉瘤复发迹象的病人应该有完整的病史和体格检查。应进行诊断性活检，细针或开放活检，以确认复发。应进行肝功能检查、全血细胞计数、电解质和胸部X光检查。如果初步评估证实局部复发，并且区域或远处疾病阴性，则应进行胸部CT扫描以更好地排除转移，以及局部复发的CT或MRI。如果神经血管结构在无创扫描中出现危险，则进行动脉造影以排除主要血管受累。在选定的情况下，动脉和/或静脉重建可以指示允许完全大体切除肿瘤。对于所有切缘较近的肉瘤和任何高级别病变，无论切缘状态如何，肿瘤的完全切除应与放射治疗相结合。近距离放射治疗通常可以使用，即使当患者之前已经对该部位进行了远距离治疗。肿瘤完全切除联合辅助放疗是预防局部复发和长期生存的最佳方法。
The patient who presents with evidence of a recurrent soft-tissue sarcoma of the extremity should have a complete history and physical examination. A diagnostic biopsy, either fine-needle or open biopsy, should be performed to confirm recurrence. Liver-function tests, complete blood cell count, electrolytes, and chest X-ray should be performed. If preliminary evaluation confirms local recurrence and is negative for regional or distant disease, a CT scan of the chest to better exclude metastases, as well as a CT or MRI of the local recurrence, should be performed. If neurovascular structures appear at risk on noninvasive scanning, an arteriogram is performed to exclude major vascular involvement. In selected circumstances, arterial and/or venous reconstruction may be indicated to allow complete gross removal of tumor. Complete removal of tumor should be combined with radiotherapy for all sarcomas with close margins and for any high-grade lesion regardless of margin status. Brachytherapy can often be used even when the patient has had prior teletherapy to the site. Complete tumor removal combined with adjuvant radiotherapy is the best way to prevent subsequent local recurrence and provide long-term survival.