上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (10): 1442-1448.doi: 10.3969/j.issn.1674-8115.2026.10.015

• 短篇论著 • 上一篇    

基于“三明治”法的碘125粒子近距离放射治疗在累及软组织恶性肿瘤术中计划阳性切缘辅助治疗中的临床应用

张鹏1, 陈文永2, 刘磊1, 左冬青3, 蔡郑东3, 孙伟3()   

  1. 1.江苏省泰州市中医院（南京中医药大学泰州附属医院）骨伤科，泰州 225300
    2.昆明理工大学附属普洱医院骨科，普洱 665000
    3.上海交通大学医学院附属第一人民医院骨肿瘤科，上海 200080
  • 收稿日期:2025-12-25 接受日期:2026-08-05 出版日期:2026-10-28 发布日期:2026-10-28
  • 通讯作者: 孙 伟，主任医师，博士；电子信箱：viv-sun@sjtu.edu.cn。
  • 基金资助:
    上海交通大学医学院“双百人”项目(2024-0812)

Clinical application of sandwich-based iodine-125 seed brachytherapy for adjuvant management of intraoperatively planned positive margins in malignant tumors involving soft tissue

Zhang Peng1, Chen Wenyong2, Liu Lei1, Zuo Dongqing3, Cai Zhengdong3, Sun Wei3()   

  1. 1.Department of Orthopedics and Traumatology, Taizhou Hospital of Traditional Chinese Medicine (Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine), Jiangsu Province, Taizhou 225300, China
    2.Department of Orthopedics, Pu'er Hospital Affiliated to Kunming University of Science and Technology, Pu'er 665000, China
    3.Department of Bone Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
  • Received:2025-12-25 Accepted:2026-08-05 Online:2026-10-28 Published:2026-10-28
  • Contact: Sun Wei, E-mail: viv-sun@sjtu.edu.cn.
  • Supported by:
    “Two-hundred Talents” Program of Shanghai Jiao Tong University School of Medicine(2024-0812)

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摘要：

目的·探索使用碘125粒子近距离放射治疗（放疗）辅助处理累及软组织恶性肿瘤术中计划阳性切缘（planned positive margins，PPMs）的安全性及短期临床疗效。方法·回顾性选择2020年6月至2022年6月上海交通大学医学院附属第一人民医院骨肿瘤科接受肿瘤切除术，并在术中形成PPMs后采用“三明治”法碘125粒子植入行近距离放疗辅助治疗的25例患者为研究对象。根据接受本次手术治疗时的肿瘤状态，将患者分为原发组（16例）和复发组（9例）。收集并分析2组患者的人口学资料（年龄、性别）、肿瘤相关资料（肿瘤部位、肿瘤大小、病理类型、阳性切缘类型）、治疗相关资料（术后辅助治疗）及随访资料（随访时间、局部控制情况、治疗相关并发症）。以局部控制（local control，LC）率为主要观察指标，以治疗相关并发症为次要观察指标，比较2组患者的局部控制效果及治疗安全性。结果·25例患者中，男性19例、女性6例，平均年龄（60.9±5.8）岁；肿瘤分布于骨盆（8例）、上肢（6例）及下肢（11例）；病理类型以脂肪肉瘤（7例）、未分化多形性肉瘤（5例）和横纹肌肉瘤（3例）为主；阳性切缘类型包括邻近神经（11例）、邻近血管（6例）、邻近骨界面（4例）及邻近内脏（4例）。所有患者均完成随访，中位随访时间为［20.00（14.00，25.00）］个月，随访率为100%；其中，17例未接受术后辅助治疗，8例接受术后辅助治疗［包括化学治疗（化疗）5例、放疗1例、放化疗1例、靶向联合免疫治疗1例］。随访期间，共5例患者发生局部复发，总体LC率为80.0%（20/25）；原发组LC率为81.3%（13/16）、复发组为77.8%（7/9），且组间差异无统计学意义（P=1.000）；治疗相关并发症发生率为16.0%（4/25），其中伤口延迟愈合3例、迟发性腓总神经损伤1例。结论·碘125粒子近距离放疗可用于辅助累及软组织恶性肿瘤术中PPMs处理，具有较好的局部控制效果，治疗相关并发症发生率较低。

关键词: 累及软组织恶性肿瘤, 近距离放射治疗, 计划阳性切缘, 局部复发

Abstract:

Objective ·To evaluate the safety and short-term clinical efficacy of iodine-125 (I-125) seed brachytherapy for adjuvant management of intraoperatively planned positive margins (PPMs) in malignant tumors involving soft tissue. Methods ·This retrospective study included 25 patients who underwent tumor resection and received adjuvant brachytherapy using the sandwich-based I-125 seed implantation for PPMs in the Department of Bone Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, between June 2020 and June 2022. According to tumor status at the time of surgery, the patients were divided into the primary group (n=16) and the recurrent group (n=9). Demographic data (age and gender), tumor-related characteristics (tumor location, tumor size, pathological type, and type of positive margin), treatment-related characteristics (postoperative adjuvant therapy), and follow-up data (follow-up duration, local control status, and treatment-related complications) of the two groups were collected and analyzed. The primary outcome was the local control (LC) rate, and the secondary outcome was treatment-related complications. Local control and treatment safety were compared between the two groups. Results ·Among the 25 patients, 19 were males and 6 were females, with a mean age of (60.9±5.8) years. Tumors were located in the pelvis (n=8), upper extremities (n=6), and lower extremities (n=11). The predominant pathological types were liposarcoma (n=7), undifferentiated pleomorphic sarcoma (n=5), and rhabdomyosarcoma (n=3). PPM types included margins adjacent to nerves (n=11), blood vessels (n=6), bone interfaces (n=4), and visceral organs (n=4). All patients completed follow-up, with a mean follow-up duration of [20.00 (14.00, 25.00)] months and a follow-up rate of 100%. Among them, 17 patients received no postoperative adjuvant therapy, whereas 8 patients received postoperative adjuvant therapy, including chemotherapy (n=5), radiotherapy (n=1), chemoradiotherapy (n=1), and targeted therapy combined with immunotherapy (n=1). During the follow-up period, local recurrence occurred in 5 patients, resulting in an overall LC rate of 80.0% (20/25). The LC rate was 81.3% (13/16) in the primary group and 77.8% (7/9) in the recurrent group, with no significant difference between the two groups (P=1.000). Treatment-related complications occurred in 4 patients (16.0%), including delayed wound healing in 3 patients and delayed-onset common peroneal nerve injury in 1 patient. Conclusion ·I-125 seed brachytherapy can be used as an adjuvant treatment for PPMs in malignant tumors involving soft tissue, providing favorable local control with a relatively low incidence of treatment-related complications.

Key words: malignant tumors involving soft tissue, brachytherapy, planned positive margin (PPM), local recurrence

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