Limb function following conservation treatment of adult soft tissue sarcoma

Martin H. Robinson , Louise Spruce , Ros Eeles , Ian Fryatt , Clive L. Harmer , J.Meirion Thomas , G. Westbury
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引用次数: 76

Abstract

Quality of life and limb function were studied in 54 patients who were disease-free 2 or more years after limb-conserving treatment for soft tissue sarcoma of the leg or pelvic girdle. Tumours of the thigh predominated (25 patients) and the mean tumour size was 9.9 cm. 41 patients had been treated with a combination of surgery and radiotherapy (29 with conventional and 12 with high dose), 12 with surgery alone and one with irradiation and intra-arterial doxorubicin. Only 15 patients had a normal range of movement in all lower limb joints and only 12 had normal power in all muscle groups; tumours of the lower leg were particularly unfavourable in this respect. Gait was normal in 42 patients but 8 required a walking aid and 4 a joint support. 16 had detectable lymphoedema but only 2 needed to wear compression hosiery. 35 patients still experienced pain at some time but only 6 required analgesia. However, when assessed by questionnaire for locomotion, grooming and home/leisure/vocational activities, 37 patients (68%) reported excellent function, and only 2 had moderate impairment. Function loss was most marked in leisure (25 patients) and vocational (8) activities, but was mild in 66% of cases. Multivariate analysis was carried out to determine the prognostic factors for poor limb function. The results suggested that overall functional score was predominantly determined by gait (P < 0.001), muscle power or range of movement (P < 0.001), with increasing age, female sex and the use of radiotherapy poor prognostic factors. Reduced muscle power or range of movement were the major factors determining gait (P < 0.02) with the use of radiotherapy the significant prognostic factor for both in the conventionally treated group. Doses in excess of 60 Gy resulted in increased fibrosis and a worse functional outcome. Extent of surgery was not an independent prognostic factor for limb function, although univariate analysis suggested an association with range of movement in the conventionally treated group (P < 0.025). Despite significant objective loss of range of movement and muscle power patients retain excellent limb function and quality of life following limb conserving treatment. For optimal function, radiotherapy should be given with small fractions to a dose not exceeding 60 Gy.

成人软组织肉瘤保留治疗后的肢体功能
对54例腿部或骨盆带软组织肉瘤患者进行保肢治疗2年或更长时间后无病的患者的生活质量和肢体功能进行了研究。25例患者以大腿肿瘤为主,平均肿瘤大小9.9 cm。41例患者采用手术和放疗联合治疗(常规剂量29例,高剂量12例),12例单独手术治疗,1例放疗和动脉内注射阿霉素。只有15例患者下肢所有关节活动范围正常,只有12例患者所有肌群力量正常;小腿的肿瘤在这方面尤其不利。42例患者步态正常,但8例需要助行器,4例需要关节支撑。16例可检测到淋巴水肿,但只有2例需要穿压缩袜。35例患者仍有疼痛感,但只有6例需要镇痛。然而,当通过运动、修饰和家庭/休闲/职业活动问卷评估时,37名患者(68%)报告功能良好,只有2名患者有中度损伤。功能丧失在休闲活动(25例)和职业活动(8例)中最为明显,但66%的病例是轻度的。进行多变量分析以确定肢体功能不良的预后因素。结果表明,总体功能评分主要由步态决定(P <0.001),肌肉力量或运动范围(P <0.001),随着年龄的增加,女性和使用放射治疗预后不良的因素。肌肉力量或活动范围的减少是决定步态的主要因素(P <0.02),放疗是常规治疗组的重要预后因素。超过60 Gy的剂量导致纤维化增加和更差的功能结果。手术范围不是肢体功能的独立预后因素,尽管单因素分析表明,常规治疗组的手术范围与活动范围有关(P <0.025)。尽管运动范围和肌肉力量的客观损失显著,但患者在保肢治疗后仍保持良好的肢体功能和生活质量。为了获得最佳功能,放射治疗应以小剂量给予,剂量不超过60戈瑞。
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