Sacrectomy and Adjuvant Radiotherapy for the Treatment of Sacral Chordomas: A Single-Center Experience Over 27 Years
Sacrectomy and Adjuvant Radiotherapy for the Treatment of Sacral Chordomas: A Single-Center Experience Over 27 Years
复制标题
骶骨切除术和辅助放射治疗治疗骶骨脊索瘤：超过 27 年的单中心经验
作者：
Arjun Dhawale;Joseph P. Gjolaj;L. Holmes;L. Sands;H. Temple;F. Eismont
研究设计。回顾性队列（仅限病例）。目标。目的：评价21例骶脊索瘤整体切除加辅助放疗的治疗效果及影响患者生存的因素。背景资料摘要。对超过20例患者的骶脊索瘤治疗的长期研究很少，与生存相关的因素也不完全清楚。方法。统计学、治疗、并发症和肿瘤结果分析采用汇总统计、假设检验采用Mantel-Haenszel-Cox分析、log-rank检验、Cox比例风险模型和Kaplan-Meier生存估计（如适用）。结果。男性12例，女性9例，平均年龄61岁（16 ~ 79岁），平均随访5.8年（2 ~ 19.2年）。20例为IB期，1例为IIIB期；平均肿瘤大小为10.5 cm。联合前后路切除14例，单独后路切除7例；18例接受辅助放疗。治疗后，分别有4例和5例患者的肠道和膀胱得到控制。并发症包括：伤口感染(4)，其他伤口并发症(9)，瘘(2)，深静脉血栓形成(1)，肺栓塞(1)。中位生存期为7.2年。8例（40%）局部复发，4例（19%）转移性疾病。复发前平均无病间隔为2.5年（1-5）。在过去的9年中，没有患者（n = 8）有局部或远处疾病。肿瘤复发患者在首次复发后平均存活5.7年（范围0.8-9年）。肿瘤复发的唯一危险因素是肿瘤近端范围（P = 0.05），复发与生存之间有统计学意义的相关性（RR = 3.8； 95%可信区间1.0 ~ 15.3;P = 0.04）。结论。尽管有并发症，但通过治疗可以提高长期生存率。近端肿瘤范围可能与复发和生存有关。复发率随着时间的推移而降低，强调了一个经验丰富的多学科外科团队的重要性。证据级别：无
Study Design. Retrospective cohort (case only). Objective. To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy. Summary of Background Data. There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood. Methods. Demographics, treatment, complications, and oncological outcomes were analyzed with summary statistics, hypothesis testing with Mantel-Haenszel-Cox analysis, log-rank test, Cox proportional hazard model, and Kaplan-Meier survival estimates as applicable. Results. There were 12 males and 9 females with mean age of 61 years (16–79) and mean follow-up of 5.8 years (2–19.2). Tumor stage was IB in 20 and IIIB in one; mean tumor size was 10.5 cm. Fourteen patients underwent combined anterior-posterior resection and 7 posterior resection alone; 18 received adjuvant radiotherapy. After treatment, bowel and bladder control were present in 4 and 5 patients, respectively. Complications included: wound infection (4), other wound complications (9), fistula (2), deep vein thrombosis (1), and pulmonary embolism (1). Median survival was 7.2 years. Eight (40%) had local recurrence and 4 (19%) metastatic disease. Mean disease-free interval before recurrence was 2.5 years (1–5). No patient (n = 8) treated in the past 9 years has had local or distant disease. Patients treated for recurrent tumor survived 5.7 years on average (range, 0.8–9) after the first recurrence. The only risk factor for tumor recurrence was proximal tumor extent (P = 0.05) There was a statistically significant association between recurrence and survival (RR = 3.8; 95% confidence interval, 1.0–15.3; P = 0.04). Conclusion. Despite the complications, increased long-term survival can be achieved with treatment. Proximal tumor extent may be related to recurrence and survival. Recurrence rates have diminished over time, emphasizing the importance of an experienced multidisciplinary surgical team. Level of Evidence: N/A
DOI：
10.1016/j.ijrobp.2006.02.059
发表时间：
2006-08-01
影响因子：
7
作者：
Park, Lily;DeLaney, Thomas F.;Suit, Herman D.
通讯作者：
Suit, Herman D.