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目的探讨颌面部放疗后骨肉瘤的临床病理特征、治疗和预后。方法回顾性分析2003年1月至2012年1月中山大学附属第五医院收治的27例颌面部放疗后骨肉瘤患者的临床资料,描述其骨肉瘤发生时间、影像学表现、病理学表现以及治疗方法,并对预后情况进行随访。结果 27例患者中,2例因肿瘤侵犯广泛并多发骨转移不能手术而行姑息性化疗,但效果不佳,1年后死于肺转移和多发骨转移;1例因病变累及范围大,采用手术、化疗及放疗等综合治疗,治疗后半年肿瘤复发,1年发现肺转移,其间多次化疗效果不佳,术后1年半死亡;其余24例因病变范围相对较局限,予以手术扩大切除及化疗,10例于确诊后1～2年死亡,12例随访9个月～5年无肿瘤复发,2例失访。结论颌面部放疗后骨肉瘤恶性程度高,预后差,手术联合术前术后化疗有可能改善预后。
Objective To investigate the clinicopathological characteristics, treatment and prognosis of osteosarcoma after maxillofacial radiotherapy. Methods The clinical data of 27 patients with osteosarcoma after maxillofacial radiotherapy admitted to the Fifth Affiliated Hospital of Sun Yat-sen University from January 2003 to January 2012 were retrospectively analyzed. The time of occurrence, imaging and histopathology of osteosarcoma were described. Treatment, and prognosis were followed up. Results Of the 27 patients, 2 patients were treated with palliative chemotherapy due to extensive tumor invasion and multiple bone metastases. However, the results were poor and died of lung metastasis and multiple bone metastases one year later. One patient had a large range of involvement due to the lesion. Surgery, chemotherapy and radiotherapy and other comprehensive treatment, tumor recurrence six months after treatment, lung metastasis was found in one year, during which multiple chemotherapy ineffective, 1 and a half years after the death; the remaining 24 cases due to the lesion is relatively limited, to be surgical excision And chemotherapy, 10 cases died 1 to 2 years after diagnosis, 12 cases were followed up for 9 months to 5 years without tumor recurrence, 2 cases were lost. Conclusion Maxillofacial radiosurgery has a high degree of malignancy and poor prognosis. Chemotherapy combined with preoperative and postoperative chemotherapy may improve prognosis.