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范清宇教授赴美参加世界保肢大会暨美国骨与软组织肿瘤学会年会
文章出处:本站原创 作者:管理员 发布时间:2016-02-17 阅读次数:605

         2015年10月6日-10日,世界保肢大会暨美国骨与软组织肿瘤学会年会在美国弗洛里达州奥兰多市召开,这是全球骨肿瘤领域最顶级的学术会议。第四军医大学第二附属医院骨科范清宇主任医师受大会主席邀请赴美国参会,并作为中国唯一的受邀专家,参加组委会特意组织的“肿瘤局部消融研讨会”,且在研讨会上做题为“热疗-微波消融治疗骨肿瘤”的15分钟演讲,代表着我们的骨肿瘤治疗技术处于世界领先地位。

会后,来自世界各地的参会者反应强烈,美国梅奥医学中心与约翰霍普金斯大学终身教授、美国工程院院士赵以苏教授给与其高度评价,特附原文如下。

Summary on Local Tumor Ablation (LTA) Workshop
Prepared by Ed Chao, Emeritus Professor, Mayo Clinic & Johns Hopkins University
October 31, 2015
Background 
Bone tumors are a heterogeneous group of lesions varying from benign “no touch” to high-grade malignant lesions with metastatic potential. Systemic therapy (chemotherapy) is given in tumor that is sensitive to it (e.g. osteosarcoma and Ewing sarcoma). However, chemotherapy rarely ever completely eradicates the primary lesion. There have been no major breakthroughs in the past 30 years in local tumor control. Although radiation therapy may be able to minimize local normal tissue damage when proton beam is used, the high cost involved and long-term side effects prohibit its widespread application. In the end, in most cases, surgery remains the mainstay for local control.
Surgical techniques for local tumor control are aimed at removing the lesion and prevent local recurrence or residual disease. En-bloc excision with safe margin is performed in malignant lesions, but low-grade tumor can be curetted out only if a local residue is not harmful to the patient and can be re-treated. Curetting leads to local recurrences in up to 10% of the cases. Complete removal of tumor via en bloc resection can minimize local tumor residue, but one has to consider the tradeoff on function loss. Surgeons use basic tools like knife and curette, enhanced by local adjuvants such as cryosurgery or phenol on aggressive benign tumor, i.e., the GCT. These methods have been in clinical use in the past, but there has been little improvement in alleviating adverse effects. 
En-bloc resection of isolated tumor mass has been the standard in limb-sparing surgery and it requires modular or custom-made mega-prosthesis for reconstruction. High incidence of early and late complications, durability of the implant and reconstruction, the high cost involved and limb functional deficits are the primary concerns of such reconstruction technique. In addition, there are anatomical locations, type of tumor involved and in growing children, surgeons and bioengineers have been seeking alternatives methods to eradicate local bone tumor and attempting biological reconstruction using minimal metal implants with and without bone augmentation materials. These problems have motivated the development of reliable, effective and easy-to-use local tumor ablation techniques in the past 3 decades. Prof. QY Fan of the 4th Military Medical School in Xi’an first introduced the innovative MW hyperthermia technique and reported his impressive clinical results at the 1st CSOS (Chinese-Speaking Orthopaedic Society) meeting in Hong Kong in 1994. (西安第四军医大学 范清宇教授 于1994年在香港举行的第一届华裔骨科学会上报告了他的令人印象深刻的微波高温新技术) For the past 21 years, Prof. Fan had lectured numerous times all over the world in various orthopaedic oncology meetings. However, the best and most effective format to promote and expand this technology is through workshops combined with training courses. After 12 years’ devoted effort, I was able to finally achieve this goal during this year’s ISOLS meeting in October in Orlando, Florida, USA. 
Before summarizing the history of trying to organize it and the outcome of the present workshop, it is desirable to reiterate the advantages of MW technique: 1).The autogenous bone left behind as the scaffold to allow biological reconstruction for connective tissue regeneration; 2).Independent of preoperative adjuvant therapy; 3).Making reconstructive procedure more conservative and less costly; 4). Minimizing short and long-term side effects compared to radiation; 5). Offer better limb function and durable reconstruction. Clinical trial and basic science research results are summarized in a Poster for the 2013 ISOLS meeting in Bologna, Italy which is attached for reference.(总结微波高温技术的五项优点)
History LTA Workshop Planning
In 2001, after being on the ISOLS Board for 20 years, I resigned as the Secretary General and passed on my duties to Frank Frassica. This was done only after I successfully promoted the 2005 meeting in Seoul, Korea. As a return of my effort, I negotiated with then Korea ISOLS-President-elect the late Prof. Han Koo Lee to support 2011 ISOLS meeting in Beijing and invite Prof. QY Fan as the keynote speaker in Korea. Unfortunately, Prof. Lee succumbed to a fire accident in 2005 New Year eve and the new organization committee had no record of my unwritten agreements! During the 2003 ISOLS meeting in Rio de Janeiro, I recommended an informal early morning panel discussion on local tumor ablation techniques so that Prof. Fan could share his remarkable experience using MW technology with the members. For various reasons, this proposal was not accepted. Thanks to the enormous success of the 2008 Olympic in Beijing, it was not difficult for me to persuade the Board to have the ISOLS-2011 meeting in Beijing. I volunteered to write the 30th ISOLS Anniversary Monograph and my recommendation to invite Prof. Fan to present his landmark contribution in the field of limb salvage was accepted. Though Prof. Fan’s lecture was well received and he was subsequently invited to do the same at the APMSTS (Asian-Pacific Musculoskeletal Tumor Society) meetings in Seoul and Melbourne and the EMSOS (European Musculoskeletal Oncology Society) in Gothenburg, Sweden. However, the impact of MW technology was still minimal and I continued to push LTA workshop with strong support from my Mayo colleagues, Frank Sim and Mary O’Conner. We nearly pulled it off for the 2013 meeting in Bologna, but again, the original ISOLS President passed away just before the meeting and the organization committee has lost my workshop proposal!
2015 ISOLS LTA Workshop Outcome
Although the LTA workshop was finally held in Orlando early this month, it did not come easily. First of all, the ISOLS program committee was restricted by the rules of AMSTS (affiliated with AAOS) as this was a joined meeting. Secondly, there was strong resistance to put our workshop announcement in the ISOLS/AMSTS scientific program, thus not able to publicize our workshop for all attendees. We were also asked by the AAOS official to pay for the meeting room, which was overly expensive, but fortunately, our local Chair was kind enough to cover that. Without knowing how many participants would come, we prepared 80 chairs but there were more than 120 showed up! The presentations went well and the discussions covered all major points. At the end, everyone was thrilled including my co-chair Frank Sim from the Mayo Clinic. There were uniform praises to our effort as all attendees agreed that the local tumor ablation using MW hyperthermia and cryotherapy will be the viable future choices for local tumor control in lieu of en bloc resection. We vowed to collaborate on basic science, bioengineering and clinical research and work with the industry.
Complementary Remarks and Constructive Comments on MW Technique
1. Prof. QY Fan’s contribution in the past 30 years is definitely a landmark achievement in musculoskeletal tumor and limb salvage field. He is encouraged to write up the clinical results in several manuscripts and published in refereed journals.(在过去30年里,范清宇教授对骨肿瘤领域做出里程碑式的贡献)
2. The advancement in LTA techniques represent a major break-through in limb salvage to facilitate biological reconstruction which opens up new science and R&D for ISOLS.
3. Both MW and cryo-therapy using cold delivery probes will remain as major topics in future ISOLS meeting programs and collaborative studies.
4. The clinical trials of these technologies need to be carefully controls using carefully designed research protocols to establish strong evidence.
5. Future R&D shall focus on temperature distribution as well as ease of application. 
6. There is a strong need for instrument companies to be closely involved.
7. Strong need for Prof. QY Fan to host an intensive training course on MW ablation method.(热切期望范清宇教授组织微波消融技术训练课程)
8. Need to explore and expand applications in tumors in the pelvis and spine.
9. Computer-aided planning and execution will be crucial on antenna or probe location and treatment time according to tumor type, size and anatomical location.
10. Irreversible electroporation should be explored especially when tumor is adjacent to vital organ and systems.
11. It is worthwhile to explore the possibility of applying LTA to soft tissue tumor.

The following leaders in our field had volunteered to make the above listed complements and comments during and after the workshop. They are: Frank Sim of the Mayo Clinic(美国); Reinhard Windhager of Vienna奥地利); S. Tsuchiya of Japan(日本); YK Kang of Korea(韩国); Paul Jutte of the Netherlands(荷兰); Reynado Jesus-Garcia of San Polo, Brazil(巴西); Pietro Ruggieri of Bologna, Italy(意大利); Robert Turcotte of Montreal, Canada(加拿大); Bennie Lindeque of Denver(美国); KC Wong of Hong Kong(香港), Ed Chao of Irvine, CA(美国). (给出上述评论和建议的名单,均为本领域内的领袖级医生)

To me, this workshop was a payoff to my long and persistent effort, but to Prof. QY Fan, this should be a well-deserved recognition on his innovative work and perseverance to achieve the proof-of-concept requirement, a great and unselfish dedication to musculoskeletal oncology and limb salvage! (此次研讨会是对范清宇教授坚持不懈达到的名至实归的创新和无私奉献的认可)

Future Plans
1. There should be three international LTA workshops with training courses in 2016, one in Xi’an, China, one in the Western Part of the US and one in Europe.(在中国西安,美国西部和欧洲各办一次训练课程)
2. Explore collaborating industrial partners on MW and cryo-therapy technology.
3. Recommend instructional courses on LTA in the ISOLS-2017 meeting in Japan.(2017年在日本举办的保肢会上主旨演讲)
4. Submit abstracts related to MW and Cryo techniques to justify the separate sessions on these technologies.
5. Solicit cross-society international collaborative research program and funding opportunities.
 
 
 
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