Multimodality management of 26 skull-base chordomas with 4-year mean follow-up: experience at a single institution
Multimodality management of 26 skull-base chordomas with 4-year mean follow-up: experience at a single institution
复制标题
26 例颅底脊索瘤的多模式治疗并进行 4 年平均随访：单一机构的经验
DOI：
10.1007/s00701-004-0218-3
复制
发表时间：
2004
影响因子：
2.4
通讯作者：
M. Özek
中科院分区：
文献类型：
--
作者：
M. Pamir;T. KiliÇ;U. Türe;M. Özek
摘要客观性。分析一系列经病理证实的颅底脊索瘤患者，并根据这些数据、我们的经验和目前的文献，开发出一种治疗这种具有挑战性的疾病的算法。
材料和方法。1986年至2001年间，26名脊索瘤患者在马尔马拉大学医学院接受了传统手术、颅底外科技术和伽玛刀手术的各种组合的多模式治疗。共施行57例手术，其中肿瘤切除43例，伽玛刀7例，其他并发症7例。平均随访4年(48.5个月)。使用Karnofsky评分跟踪患者的临床情况，并使用磁共振图像分析来测量肿瘤体积随时间的变化。
结果。7名患者在随访期间死亡。其中两人死于手术并发症，四人死于与肿瘤复发有关的临床恶化，一人与肿瘤无关。第一次手术后肿瘤复发率为58%。在采用颅底入路作为一线治疗的病例中，残留肿瘤体积较低。从最初的诊断到最近的随访检查，19名幸存者的临床状态几乎没有变化。伽玛刀治疗后的平均随访时间为23.3个月。在此期间，平均肿瘤体积比伽玛刀手术时的平均体积增加了28%。在同一时间段内，平均Karnofsky评分下降了6%。
结论。脊索瘤患者最有效的一线治疗是手术。残留肿瘤体积的研究结果表明，颅底入路是最好的手术选择，而且这些技术的并发症发生率是可以接受的。然而，手术从生物学上根除这种疾病的情况很少见，数据显示，如果诊断时肿瘤体积超过20 cm~3，这些脊索瘤几乎总是进展。基于我们的经验和疾病的生物学特征，我们现在提倡在一线颅底手术后立即进行放射外科治疗(我们的病例中为伽玛刀)，此时肿瘤残留体积为<；30 cm~3。
SummaryObjective. To analyze a series of patients with pathologically confirmed skull-base chordoma, and to develop an algorithm for the management of this challenging disease based on the data, our experience, and the current literature.
Material and methods. Between the years 1986 and 2001, 26 chordoma patients received multimodality treatment with various combinations of conventional surgery, skull-base surgical techniques, and gamma-knife surgery at the Marmara University Faculty of Medicine. A total of 57 procedures (43 tumor excision surgeries, 7 gamma-knife procedures, and 7 other operations to treat complications) were performed. The mean follow-up period was 4 years (48.5 months). Karnofsky scoring was used to follow the patients’ clinical conditions, and magnetic resonance image analysis was used to measure tumor volume over time.
Results. Seven patients died during follow-up. Two of the deaths were due to surgical complications, four resulted from clinical deterioration related to tumor recurrence, and one was unrelated to neoplasia. The rate of tumor recurrence after the first surgical treatment was 58%. Residual tumor volume was lower in the cases in whom skull-base approaches were used as first-line management. The 19 survivors showed little change in clinical status from initial diagnosis to the most recent follow-up check. The mean follow-up time after gamma-knife treatment was 23.3 months. During this period, mean tumor volume increased 28% above the mean volume at the time of gamma-knife surgery. The mean Karnofsky score decreased by 6% during the same time frame.
Conclusions. The most effective first-line treatment for chordoma patients is surgery. The findings for residual tumor volume indicated that skull-base approaches are the best surgical option, and the complication rates for these techniques are acceptable. However, it is rare that surgery ever biologically eradicates this disease, and the data showed that these chordomas almost always progress if the tumor volume at the time of diagnosis exceeds 20 cm3. Based on our experience and the biological character of the disease, we now advocate radiosurgical treatment (gamma-knife in our case) immediately after the first-line skull-base surgery when the tumor residual volume is <30 cm3.
影响因子：
4.1
作者：
AUSTINSEYMOUR, M;MUNZENRIDER, J;SUIT, HD
通讯作者：
SUIT, HD