High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors
High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors
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DOI：
10.3171/2015.3.spine14716
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发表时间：
2015-12-01
影响因子：
2.8
通讯作者：
DeLaney, Thomas F.
中科院分区：
文献类型：
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作者：
Rotondo, Ronny L.;Folkert, Wendy;DeLaney, Thomas F.
对象 脊柱脊索瘤在接受或不接受常规剂量放射治疗 (RT) 的手术后可能具有较高的局部复发率。对进行或不进行手术的高剂量质子放疗后的治疗结果和预后因素进行了评估。 方法 作者对 126 名接受治疗的患者（127 个病灶）进行了回顾性分析，根据疾病状态（原发性与复发性）、切除情况（整块与病灶内）、切缘状态和放疗时间进行分类。 结果 71 例骶尾部患者、40 例腰椎患者和 16 例腰椎患者 分析了胸部脊索瘤。平均 RT 剂量为 72.4 GyRBE（相对生物有效性）。中位随访时间为 41 个月，整个队列的 5 年总生存率 (OS)、局部控制 (LC)、局部区域控制 (LRC) 和远处控制 (DC) 分别为 81%、62%、60% 和 77%。原发性脊索瘤的 LC 为 68%，而复发性病变的 LC 为 49% (p = 0.058)。如果术前接受 RT 治疗，LC 率为 72%，而没有接受该治疗的 LC 率为 54% (p = 0.113)。在原发性肿瘤中，术前放疗的 LC 和 LRC 较高，分别为 85% (p = 0.019) 和 79% (0.034)，而如果未提供术前放疗，LC 和 LRC 分别为 56% 和 56%。与病灶内切除相比，整体 LC 显着改善（72% vs 55%，p = 0.016），LRC 也是如此（70% vs 53%，p = 0.035）。我们注意到 RO/R1 边缘的 LC 和 LRC 有所改善，并且无需进行病灶内手术。 结论 在脊髓脊索瘤的治疗中，高剂量基于质子的放疗可能是有效的治疗方法。在接受手术的患者中，原发性脊索瘤接受术前放疗、整块切除和术后加强放疗的患者局部肿瘤控制率最高； 28 名原发性脊索瘤患者接受术前放疗和整块切除，未发现局部复发。病灶内和不完全切除与较高的局部失败率相关，应避免。
OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed.METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing.RESULTS Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for RO/R1 margins and the absence of intralesional procedures.CONCLUSIONS High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.