Disease outcomes for skull base and spinal chordomas: A single center experience
Disease outcomes for skull base and spinal chordomas: A single center experience
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DOI：
10.1016/j.clineuro.2014.12.015
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发表时间：
2015-03-01
影响因子：
1.9
通讯作者：
Hitchon, Patrick W.
中科院分区：
文献类型：
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作者：
Ahmed, Raheel;Sheybani, Arshin;Hitchon, Patrick W.
目的：由于脊索瘤的生长方式和手术切除的限制，脊索瘤的发病率很高。如果可行，整块切除是理想的治疗目标，但与显著的发病率有关。我们试图阐明手术范围、位置和放疗与总体疾病和无进展生存期(PFS)的关系。方法：我们回顾了1978-2010年间所有经组织病理学诊断为斜坡型和脊索瘤的患者的病例记录。结果：共有49例患者(位置：30例，颅底/斜坡型；12例脊柱；7例骶骨)获得平均6.3年(0.25个月-33年)的随访。与大部切除组(n=41，55%和31%)相比，大部切除组(n=8，5年和10年生存率分别为88%和31%)的5年和10年生存率显著提高(p<0.05，GTR和STR组)。大剂量立体定向分割放射治疗(HS-FSRT)明显改善了颅颈脊索瘤患者的5年生存率(70%，n=13)，与标准剂量放射治疗(20%，n=16；p值=0.03)相比有显著改善。总体而言，接受HD-FSRT的颅颈患者的10年生存率(40%)与传统放射治疗(45%)相比没有显着差异。骶骨脊索瘤预后最差，3年生存率为28.6%。结论：肿瘤根治术预后最好，可提高患者的长期生存率。辅助HD FSRT治疗颅颈/斜坡脊索瘤可显著提高无病存活率，但对存活率的长期益处尚未确定。骶骨脊索瘤预后较差，长期存活率较低。(C)2014爱思唯尔B.V.保留所有权利。
Objective: Chordomas carry significant morbidity due to their growth patterns and surgical constraints in resection. En bloc resection, when feasible, is the ideal treatment goal, but is associated with significant morbidity. We sought to elucidate the relationship between extent of surgery, location and radiotherapy in relation to overall disease and progression free survival (PFS).Methods: We reviewed case records for all patients with a primary histopathological diagnosis of clival and spinal chordomas that was presented to our institution between 1978 and 2010.Results: A total of 49 patients (location: n = 30, skull base/clival; n = 12 vertebral column; n = 7 sacrum) were identified with mean follow-up period of 6.3 years (range 0.25 months-33 years). Improved 5 year and 10 year survival rates were noted following gross total resection (n = 8, 5 year and 10 year survival = 88%) as compared to patients that underwent subtotal resection (n = 41,55% and 31%, respectively), (p-value >0.05, GTR versus STR). Adjuvant high-dose stereotactic fractionated radiotherapy (HS-FSRT) significantly improved 5 year PFS in craniocervical chordoma patients (70%, n = 13) as compared to standard dose radiation therapy (20%, n = 16; p-value = 0.03). Overall 10 year survival for craniocervical patients undergoing HD-FSRT (40%) was however not significantly different in comparison with conventional radiotherapy (45%). Sacral chordomas had the worst prognosis with 3 year survival of 28.6%.Conclusions: GTR offers the best prognosis for improved long-term survival. Adjuvant HD FSRT for craniocervical/clival chordomas significantly improves disease free survival though the long-term benefits on survival have yet to be established. Sacral chordomas are associated with a worse prognosis and poor long-term survival. (C) 2014 Elsevier B.V. All rights reserved.