請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55639
標題: | 使用外科手術及低分次放療在貓注射相關肉瘤之治療安排 Surgery and Hypofractionated Radiation Therapy Arrangement for Feline Injection Site-associated Sarcoma |
作者: | Han-Yun Cheng 鄭涵勻 |
指導教授: | 李繼忠(Jih-Jong Lee) |
關鍵字: | 貓注射部位相關肉瘤,低分次放射治療,手術, Feline injection site-associated sarcoma,Hypofractionated radiation therapy,Surgery, |
出版年 : | 2020 |
學位: | 碩士 |
摘要: | 由於貓注射部位相關肉瘤具有強烈局部侵犯性,局部腫瘤控制成為重要且具挑戰性的議題,合併放射治療及大範圍手術等多種治療方式可能有較佳的預後。 本回溯性研究目的為比較不同治療方式安排的成效,包含單用手術、單用低分次放射治療以及併用兩者。回溯國立臺灣大學附設動物醫院 2005 年至 2019 年之間的病例,共有 65 隻罹患注射部位相關肉瘤的貓被納入本研究。根據不同的治療方式安排將患貓分為四組,包含手術併用術後低分次放射治療、術前低分次放射治療併用手術、單用低分次放射治療及單用手術。 比較術前低分次放射治療併用手術組及單用低分次放射治療組,腫瘤最大直徑、放射治療總劑量及對於放射治療之反應在兩組間均無顯著差異。中位無疾病進展期亦無顯著差異,分別為 206 天(95% 信賴區間(CI)0–437 天)及 150 天 (95% CI 109–191 天)(P = 0.259)。然而,中位存活時間在術前低分次放射治療併用手術組則顯著較長,分別為687天(95% CI 0–1598天)及248天(95% CI 160—336 天)(P = 0.009)。 比較手術併用術後低分次放射治療組及單用手術組,腫瘤最大直徑、中位無疾病進展期及中位存活時間均無顯著差異。中位無疾病進展期分別為 460 天(95% CI 292–628 天)及 410 天(95% CI 0–910 天)(P = 0.823),中位存活時間分別為 952 天(95% CI 602–1302 天)及 779 天(95% CI 533–1025 天)(P = 0.646),局部腫瘤復發率分別為 44%及 50%。 比較術前及術後使用低分次放射治療的兩組,發現術前放射治療組有顯著較大的腫瘤最大直徑,其為可能影響預後的重要因子,因此無法比較出術前或是術後的低分次放射治療為較佳的治療安排。而在 4 組間比較,單用放射治療的患貓比起其他 3 組有顯著較短的中位存活時間(P < 0.001、P = 0.009 及 P = 0.001)。 總結本研究,在有巨觀團塊且腫瘤直徑較大時,術前低分次放射治療併用手術比起單用低分次放射治療有明顯較佳的腫瘤控制效果。關於術前與術後低分次放射治療在貓注射部位相關肉瘤治療上扮演的角色,未來有待更大規模前瞻性且隨機分組的研究加以證實。 Local tumor control of feline injection site-associated sarcoma (FISS) has been a challenging issue due to the locally aggressive behavior. Multimodality therapy, which consisted of radical surgery and radiation therapy (RT) might result in better outcome. The aim of this retrospective study was to compare the efficacy of different local treatment arrangements including either surgery, hypofractionated RT, or in combination. Sixty-five cats diagnosed with FISSs in National Taiwan University Veterinary Hospital from 2005 to 2019 were enrolled retrospectively. Based on the arrangement of treatments, cats were divided into four groups, including adjuvant RT (ART), neoadjuvant RT (NRT), RT alone (RT), and surgery alone (SA). Between the NRT and RT group, no significant difference was noted in tumor diameter, the total dose of radiation therapy, and response to radiation therapy. The median progression-free survival (PFS) was 206 days [95% confidence interval (CI) 0–437 days] for NRT and 150 days [95% CI 109–191 days] for RT alone group (P = 0.259), while the median overall survival time (OST) was significantly longer in the NRT group than that in the RT group (687 days [95% CI 0–1598 days] versus 248 days [95% CI 160–336 days], P = 0.009). Between the ART and SA group, the tumor diameter, median PFS (460 days [95% CI 292–628 days] versus 410 days [95% CI 0–910 days], P = 0.858) and median OST (952 days [95% CI 602–1302 days] versus 779 days [95% CI 533–1025 days], P = 0.646) were not significantly different. The local recurrence rates were 44% and 50% for the ART and SA groups, respectively. Significantly larger tumor size was found in the NRT group compared to the ART group, and therefore became a possible confounding factor. Among all groups, cats in the RT group had significantly shorter median OST than the other groups (P < 0.001, P = 0.009 and P = 0.001). In conclusion, neoadjuvant RT followed by surgery led to a better tumor control than RT alone in patients with large macroscopic disease. A further prospective randomized study was warranted to identify the role of adjuvant and neoadjuvant hypofractionated RT in the management of FISS. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55639 |
DOI: | 10.6342/NTU202002035 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床動物醫學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
U0001-2907202014482600.pdf 目前未授權公開取用 | 1.09 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。