貓注射部位肉瘤手術配合術中近接放射線治療與手術治療及手術配合術後低分次放射治療之比較

Abstract

術中近接放射線治療是一種在腫瘤手術移除後針對切除範圍直接給予一次高劑量放射線的治療方式。貓注射部位肉瘤是一種局部侵犯性強的腫瘤類型。手術後再搭配放射線治療被認為可能會有較好的局部治療效果。目前針對此病患族群，術中近階放射線的治療效果以及副作用尚未被研究過。本篇文獻目的為比較手術配合術中近接放射線治療與單純接受手術及手術配合術後低分次放射治療的病患進行比較。 本篇文獻回溯2016年七月至2021年十二月於國立台灣大學附設教學動物醫院經組織病理學診斷為貓注射部位肉瘤之病歷資料。 共有24隻病患納入研究。分成手術及近接放射線治療組、純手術組和手術以及術後低分次劑量放射線治療組。在手術及近接放射線治療組和純手術組的比較中，兩組的中位無疾病期以及中位存活期並無顯著差異 (P = 0.094) (P = 0.222). 手術及近接放射線治療組和手術以及術後低分次劑量放射線治療組之間，中位無疾病期及中位存活期亦無統計差異 (P = 0.438和P = 0.125). 在副作用方面，兩組放射線治療出現急性副作用的病患比例無顯著差異，延遲性副作用的比例在接受術後低分次放射線治療的組別比例顯著較高 (P = 0.006)。但所有副作用皆為一級皮膚或毛髮之毒性。整體而言兩種治療皆有良好的耐受性。預後因子如包含腫瘤大小、組織病理學的惡性程度以及分裂向的多寡，在不同組別中會影響無疾病期。 總結而言，總結來說，本研究未能提供術中近接放射線治療的有效性證據。與僅接受手術的組別相比，中位無疾病期、存活時間和局部復發率都未有顯著較好之預後。與接受術後低分次放射線治療的組別相比，預後結果相仿，但可能與選樣差異有關。

Intraoperative radiotherapy (IORT) utilizes a single high radiation dose to a surgically-opened tumor bed. Feline injection-site sarcoma (FISS) is a tumor featuring aggressive local invasion. Surgery followed by radiation therapy (RT) may lead to better local control compared with surgery only. The efficacy and adverse effects of IORT have not been clarified in this group of patients. This article compares surgery and IORT versus surgery alone and surgery followed by hypo-fractionated RT for treating FISS. Medical records for cats with a FISS receiving wide-margin surgery, with or without IORT, with or without post-surgical hypo-fractionated RT, were reviewed retrospectively between July 2016 and December 2021 in the National Taiwan University Veterinary Hospital. Twenty-four cats were recruited and divided into surgery with the IORT group (Sx + IORT, n=12), surgery alone group (Sx, n=8), and surgery followed by the hypo-fractionated RT group (Sx + RT, n=14). No significant differences in median PFS (P = 0.094) and MST were identified between Sx + IORT group and the Sx group (P = 0.222). Between Sx + IORT and Sx + RT groups, there were no significant differences in PFS and survival time (P = 0.438 and P = 0.125). Mild acute or delayed adverse effects were identified in Sx + RT group. For acute radiation toxicity, a statistically different was noted between (P = 0.006). There was no significant difference in late adverse effects between them. Prognostic factors, including primary tumor diameter, presence of local recurrence, and mitotic count, were identified in certain groups In conclusion, the present study did not provide evidence of the effectiveness of IORT. Compared to the group that underwent surgery alone, no significant improvements were demonstrated in median PFS, OST, and local recurrence rate. Similar prognostic outcomes were observed compared to the group receiving postoperative hypo-fractionated radiotherapy.