The Role of Radiotherapy in the Treatment of Pigmented Villonodular Synovitis
J Kodiyan, RA Zlotecki, M Scarborough, J Reith, WM Mendenhall
Hong Kong J Radiol 2017;20:47-52
DOI: 10.12809/hkjr1715385
Background: This article reviews our 47-year experience of radiotherapy (RT) as adjuvant treatment for histologically confirmed pigmented villonodular synovitis (PVNS).
Methods: We identified seven women and two men with diffuse PVNS of the knee (n = 8) or hip (n = 1) who were treated with postoperative RT between 1969 and 2015 at the University of Florida. The median patient age was 59 (range, 39-79) years. The median follow-up was 5.5 (range, 2.1-26.0) years. All patients received megavoltage external-beam RT using three-dimensional conformal techniques. The median RT dose was 36 (range, 19-45) Gy in a median of 18 (range, 13-36) fractions; four patients received twice-daily fractionation, and five once daily.
Results: Of the nine patients, five had clinically and / or radiographically stable disease or were disease-free; three failed to achieve local control; and one had a questionable local recurrence based on magnetic resonance imaging 4 months later. None had acute or long-term complications from RT.
Conclusion: Synovectomy and watchful waiting remains the primary management for PVNS. In cases of extensive disease with incomplete excision and / or local recurrence, local RT should be considered.
Authors’ affiliations:
J Kodiyan, RA Zlotecki, WM Mendenhall: Department of Radiation Oncology, University of Florida
College of Medicine, Gainesville, FL, USA
M Scarborough: Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
J Reith: Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA
中文摘要
放射治療在治療色素性絨毛結節滑膜炎的應用
J Kodiyan, RA Zlotecki, M Scarborough, J Reith, WM Mendenhall
背景：本文回顧我們47年應用放療作為輔助手段治療色素性絨毛結節滑膜炎（PVNS）的經驗。
方法：回顧分析7名女性和2名男性患有膝（8例）或髖（1例）關節PVNS並在1969年至2015年在佛羅里達大學接受術後放射治療的患者。患者的年齡中位數為59歲（範圍：39-79歲）。中位數隨訪期為5.5年（範圍：2.1-26.0年）。所有患者接受兆伏級外束三維適形技術放射治療。劑量中位數為36 Gy（範圍：19-45 Gy）；分為13-36次給予照射（中位次數：18次）。4名患者接受每日2次的分次治療，5名接受每日一次分次治療。
結果：在9名患者中，5名病情穩定或無疾病；3名未能控制局部病變；1名4個月後磁共振成像疑似局部復發。沒有患者發生放療導致的急性或長期併發症。
結論：滑膜切除和觀察等待仍然是治療PVNS的主要方法。在不完全切除和/或局部復發的大範圍病變的情況下，應考慮局部放射治療。