| BackgroundSoft tissue tumors are a class of tumors originating from such connective tissues as fibrous tissues,fat,synovium,smooth muscles,striated muscles,mesothelium,blood vessels,mucus and lymphatic vessels,and neuroectoderm,etc.[1] The incidence of malignant soft tissue tumors stands at about 1.28/100,000 to 1.72/10,000,and they account for 0.73%-0.81% of all malignant tumors in adults and 6.5% of malignant tumors in children aged below 15 years.The tumors often occur in the limbs,retroperitoneum,pelvic,chest and abdominal walls or the back,adjacent to the nerves,the gastrointestinal tract,the ureter,the bladder and other organs.50%-60% of such tumors occur in the limbs,20%-25% in the retroperitoneum and abdominal cavity,15%-20% in the trunk(chest and abdominal walls and the back),and 5% in the head and neck.[1] WHO classifies soft tissue tumors into 19 tissue types and more than 50 subtypes,and the common pathological types include undifferentiated pleomorphic sarcoma,liposarcoma,leiomyosarcoma,synovial sarcoma,and malignant schwannoma.[2] However,different types of such tumors share common characteristics,that is,most of the tumors do not have regional lymph node metastasis,mainly local infiltration growth.However,angiosarcoma,clear cell sarcoma and rhabdomyosarcoma have a high rate of regional lymph node metastasis,and the common sites for distant metastases are lungs,bones,liver,brain,retroperitoneum and so on.[3]At present,the multidisciplinary treatment model should be followed in the treatment of malignant tumors,and the treatment of malignant soft tissue tumors calls for the involvement of surgery,oncology,radiotherapy,imaging(including CT,MRI,nuclear medicine,and imaging intervention),and pathology.Multiple studies have confirmed that for the vast majority of malignant soft tissue tumors,surgical resection represents the only possible radical treatment.[4] The commonly used surgical methods for malignant soft tissue sarcomas located in the limbs include interventricular resection,extensive resection and amputation;for malignant soft tissue sarcoma located in the trunk,the rate of surgical resection is much lower than that for the limbs,and the rate of local control is lower than for the limbs;for malignant soft tissue tumors located in the pelvis,palliative reduction surgery is often performed since the wide involvement of tumors in important organs,blood vessels and nerves renders operations difficult.Although surgery is the first choice for malignant soft tissue tumors,there are still many problems.First,surgery is successfully performed in only about 70% of patients,and nearly 30% of patients have failed surgery or are unable to undergo surgery.Second,the rates of postoperative recurrence and metastasis are as high as 40%-50% and the rate of distant metastases exceeds 50%.[5] Re-resection after postoperative recurrence or resection is still an important treatment modality.However,many patients cannot tolerate or refuse to re-operation after relapse due to poor health,high costs and so on;for some patients,high degree of tumor malignancy and recurrence rate after surgery render reoperation meaningless.[5]More than 10% of patients,when confirmed,already have distant metastasis,and for some confirmed patients,tumors have involved a wide range of important organs,blood vessels,nerves and joints,etc.,they refuse surgery since the tumor cannot be completely removed.So for these patients who have lost the change of radical surgery or patients with postoperative recurrence and metastasis,how to increase the local control rate on the basis of comprehensive treatment,improve quality of life and prolong survival,is a major problem facing a large number of oncology workers.In this study,we applied CT-guided argon-helium cryoablation for the treatment of malignant soft tissue tumors,evaluated its efficacy and safety,and analyzed the factors affecting the efficacy and safety,providing the basis for how to choose the indications of CT-guided argon-helium cryoablation for the treatment of malignant soft tissue tumors.The main innovations of this research are as the follows1.All the paitents we selected were local recurrence or limited metastasis,and all the lesions were treated by CT-guided cryoablation.2.In the treatment of malignant soft tissue tumors in high-risk areas,we combined with 125 I implantation,under the help of injecting saline,air or balloon separation techniques to incease the distance between the target lesion and the dangerous oragans.3.Many statistical methods were used to analyse the effects of the treatment of cryoablation for malignant soft tissue tumors.4.This study summarized the advantages of cryoablaion for recurrence after operation.This study is divided into 3 parts:Part 1 The Study on the safety of CT-guided percutaneous conformal cryoablation for malignant soft tissue tumorsObjective To explore the safety of CT-guided argon-helium cryoablation for the treatment of malignant soft tissue tumors,perform a statistical study on the incidence of common complications,and analyze the risk factors affecting the incidence of complications.Materials and Methods A total of 93 patients with malignant soft tissue tumors admitted to our hospital from January,2012 to January,2017 were enrolled.According to the inclusion criteria and exclusion criteria,a total of 60 patients were choosed.The incidence of early complications and risk factors were assessed using ?2 test or Fisher exact test method,and multivariate analysis was performed by means of logistic regression.Results Surgery was successfully performed on all the patients,and no cases of terminated surgery were seen due to pain and other reasons.After the argon-helium cryoablation,a total of 26 patients presented with varying degrees of complications,with the total incidence of complications being 43.3%.Adverse reactions and mild complications occurred in 19 cases and severe complications in 7 cases,with no surgery-related deaths.The common complications included fever(19 cases),postoperatively increased pain(7 cases),peripheral organ tissue injury(15 cases,including frostbite of skin in 7 cases,nerve injury in 6 cases,colonic bladder injury in 1 case,and bladder injury in 1 case),pleural effusion(4 cases),myoglobinuria(2 cases),and thrombocytopenia(2 cases).The rate of postoperative fever in cases with a maximal diameter of tumors > 5cm was higher than those with a maximal diameter <5cm,p = 0.05.The probability of development of adjacent organ tissue injury in cases where the tumor was ?1cm away from the dangerous organs was higher than those where the tumor was >1cm away from the dangerous organs,P = 022;the probability of postoperative immediate pain in cases where the tumors were in superficial body length was higher than those where the tumors were in deep body,P <0.001.Conclusion1,CT-guided argon-helium cryoablation for the treatment of patients with malignant soft tissue tumors is well tolerated.2,The common complications of CT-guided argon-helium cryoablation for the treatment of malignant soft tissue tumors include fever,peripheral organ injury,short-term aggravated pain after surgery,pleural effusion,myoglobinuria,and thrombocytopenia.3,Fever occurs commonly in cases with larger tumors and peripheral organ injury occurs commonly in tumors close to dangerous organs,and cases with superficial tumors are prone to short-term intensified pain.4,CT-guided argon-helium cryoablation for the treatment of malignant malignant soft tissue tumors shows a high safety profile.Part 2 Short-term efficacy evaluation of CT-guided cryoablation for the treatment of malignant soft tissue tumorsObjective To evaluate the short-term efficacy of CT-guided percutaneous argon-helium cryoablation for the treatment of malignant soft tissue tumors,and explore the factors affecting the short-term curative effect of CT-guided argon-helium cryoablation for the treatment of malignant soft tissue tumors.Materials and Methods The materials was the same to part 1.The short-term efficacy was evaluated according to the margins of immediately postoperative ice balls and the m RECIST criteria.Both the preoperative and postoperative pain degree and the preoperative and postoperative physical function status scores were recorded by VAS scoring and KPS scoring.Independent test t test was adopted for continuous variables,the ?2 test or Fisher exact test was used for classification variables,and multivariate analysis was performed by means of logistic regression.Results The rate of full coverage ice balls immediately after operation was 60%,and the effective freezing of reduced tumors was 40%.The CRs,PRs and ORRs at 1 month,3 months and 6 months after surgery were 51.7%,51.7% and 43.3%,43.3%,30% and 26.7%,and 95%,81.7% and 70%,respectively.Tumor size,location and the distance from the adjacent organ distance were factors that affected intraoperative ice ball margins,and P values were 0.002,0.023,and 0.000,respectively.The VAS pain scores prior to surgery,at 24 h,1 week,1 month,3 months and 6 months were(6.30 ± 1.38)points,(2.78 ± 2.23)points,(1.52 ± 2.10)points,(1.96 ± 2.66)points,(1.59 ± 2.56)points and(2.19 ± 3.05)points,respectively,t values were 11.96,13.29,9.993,10.946 and 8.059,respectively,and the P values were 0.000,0.000,0.000,0.000 and 0.000,respectively.The pain relief rates were 86.2%,89.7%,89.7%,86.2% and 75.9%,respectively at 24 h,1 week,1 month,3 months and 6 months after surgery,respectively.The KPS functional status score was increased from preoperatively 71.6 ± 10.76 to 79.17 ± 10.46 postoperatively,t = 5.90,and P <0.001.ConclusionArgon-helium cryoablation shows definite short-term efficacy in the treatment of malignant soft tissue tumors.2.CT-guided percutaneous argon helium cryoablation can effectively relieve local pain and increase KPS scores.3.Tumor size,location,and distance from the adjacent organs distance are the factorsPart 3 Evaluation of long-term efficacy of CT-guided cryoablation for thetreatment of malignant soft tissue tumorsObjective To evaluate the long-term efficacy of CT-guided percutaneous argon-helium cryoablation for the treatment of malignant soft tissue tumors,and explore the factors affecting PFS and OS in argon-helium cryoablation for the treatment of malignant soft tissue tumors.Materials and Methods The materials was the same to part 1.All the patients had postoperative recurrence or metastasis,and all the lesions were treated with CT-guided percutaneous argon-helium cryoablation.PFS,LPFS,RPFS,1-year survival rate,2-year survival rate and 3-year survival rate were recorded during the follow-up which lasted from the cryoablation until the loss of follow-up and patient death,and ended in June,2017.Kaplan-Meier analysis was employed to analyze patients' PFS and survival rate,and the results were validated by Log-rank test.The factors that affected PFS and OS were analyzed by means of the the cox risk model.Results: The follow-up was 3-47 months in duration and the median follow-up duration was 17.5 months.The mean RPFS,RPFS and PFS were(8.76 ± 9.09)months,(12.19 ± 8.98)months,and(10.53 ± 9.12)months,respectively,and the 1-year,2-year and 3-year survival rates using argon-helium cryoablation were 75.6 %,33.3%,9.52%,respectively.The mean OS was(20.4 ± 10.52)months.Univariate and multivariate analysis showed that tumor size and tumor distance from the risky organ distance are risk factors of PFS and OS.Conclusion:1.CT-guided argon-helium cryoablation confers definite long-term efficacy.2.Tumor size and tumor distance from the risky organ distance are factors affecting OS and PFS of CT guided argon cryoablation cryoablation. |
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