CHORDOMAS AND CHONDROSARCOMAS OF THE CRANIAL BASE - RESULTS AND FOLLOW-UP OF 60 PATIENTS
CHORDOMAS AND CHONDROSARCOMAS OF THE CRANIAL BASE - RESULTS AND FOLLOW-UP OF 60 PATIENTS
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DOI：
10.1227/00006123-199505000-00001
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发表时间：
1995-05-01
期刊：
影响因子：
4.8
通讯作者：
SNYDERMAN, CH
中科院分区：
文献类型：
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作者：
GAY, E;SEKHAR, LN;SNYDERMAN, CH
涉及颅底的脊索瘤和软骨肉瘤的处理仍有争议。治疗的选择包括活检、部分切除、根治性切除和各种形式的放射治疗。在这篇文章中，我们分析了1984年至1993年期间60例颅底脉络膜或软骨肉瘤患者的结果，这些患者接受了广泛的手术切除。46名患者患有脊索瘤，14名患有低度恶性软骨肉瘤;这些患者中有50%以前接受过治疗。术前研究包括计算机断层扫描、磁共振成像、脑血管造影和颈内动脉球囊闭塞试验。在随访期间对所有患者进行磁共振成像。用于肿瘤切除的手术入路主要有以下几种：颞下、经骨突、经海绵窦和经岩尖;颞下和颞下;扩大额部;和极外侧经髁。必要时（52%的病例）采用分期手术结合多种方法更完全地切除肿瘤。采用卡方检验和相关矩阵进行统计学分析。67%的患者进行了全切除或接近全切除。20%的患者接受了术后放疗。11名患者在术后随访期间死亡，9名为脊索瘤，2名为软骨肉瘤。3例患者在术后3个月内死于全身并发症，5例死于肿瘤复发，1例死于无关原因，2例死于放疗晚期并发症。所有肿瘤的3年无复发生存率为80%，5年为76%。软骨肉瘤的预后比脊索瘤好（5年无复发生存率分别为90%和65%; P = 0.09）。既往接受过手术的患者复发风险（5年无复发生存率，64%）高于既往未接受过手术的患者（5年无复发生存率，93%; P < 0.05）。全切除或近全切除的患者5年无复发生存率（84%）高于部分或次全切除的患者（64%）（P < 0.05）。术后脑脊液漏是最常见的并发症（30%的患者），并被发现会增加永久性残疾的风险。既往接受过放疗的患者在术后（手术后3个月内）和随访期间死亡的风险更大。然而，全切除或接近全切除并不增加术后残疾率。对于颅底脊索瘤和软骨肉瘤，在合适的患者中，全切除或近全切除应是首选的治疗方法。如果肿瘤不能完全切除，建议使用高能粒子或聚焦辐射进行放射治疗。
THE MANAGEMENT OF chordomas and chondrosarcomas involving the cranial base remains controversial. The options for therapy include biopsy, partial resection, radical resection, and various forms of radiotherapy. In this article, we analyze the outcome of 60 patients with cranial base chordoma or chondrosarcoma treated with extensive surgical resection between 1984 and 1993. Forty-six patients had chordomas, and 14 had low-grade chondrosarcomas; 50% of these patients had been treated previously. Preoperative studies included computed tomography, magnetic resonance imaging, cerebral angiography, and balloon occlusion test of the internal carotid artery, as indicated. Magnetic resonance imaging was performed on all patients during follow-up. The surgical approaches used for tumor resection were predominantly the following: subtemporal, transzygomatic, transcavernous, and transpetrous apex; subtemporal and infratemporal; extended frontal; and extreme lateral transcondylar. Staged operations with a combination of approaches were used when necessary (52% of cases) to remove a tumor more completely. Statistical analysis was done by the chi(2) test and correlation matrix. Sixty-seven percent of the patients had total or near-total resection. Twenty percent of the patients received postoperative radiotherapy. Eleven patients died during the postoperative follow-up period, nine with chordomas and two with chondrosarcomas. Three patients died because of systemic complications within 3 months after surgery, five died because of tumor recurrence, one died from unrelated causes, and two died from late complications of radiotherapy. The recurrence-free survival rate for all tumors was 80% at 3 years and 76% at 5 years. Chondrosarcomas had a better prognosis than chordomas (recurrence-free survival rates, 90% at 5 years and 65% at 5 years, respectively; P = 0.09). Patients who had undergone previous surgery had a greater risk of recurrence (5-year recurrence-free survival rate, 64%) than did patients who had not undergone previous surgery (5-year recurrence-free survival rate, 93%; P < 0.05). Patients with total or near-total resection had a better 5-year recurrence-free survival rate (84%) than did patients with partial or subtotal resection (64%) (P < 0.05). Postoperative leakage of cerebrospinal fluid was the most frequent complication (30% of patients) and was found to increase the risk of permanent disability. Patients who had undergone previous radiotherapy had a greater risk of death in the postoperative period (within 3 months of their operations) and during follow-up. However, total or near-total resection did not increase the rate of postoperative disability. In suitable patients, total or near-total surgical resection should be the preferred treatment for patients with chordomas and chondrosarcomas of the cranial base. Radiotherapy with high-energy particles, or by focused radiation, is recommended if the tumor cannot be totally removed.