Yoneoka Y, Tsumanuma I, Fukuda M, Tamura T, Morii K, Tanaka R, Fujii Y
Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Japan.
Acta Neurochir (Wien). 2008 Aug;150(8):773-8; discussion 778. doi: 10.1007/s00701-008-1600-3. Epub 2008 Jun 12.
The purpose of this study is to clarify the latest long-term therapeutic result for cranial base chordomas. We are seeking an improvement of long term therapeutic outcome through a review of cranial base chordomas treated in our institute and of the published literature in the era of multimodality therapy.
We retrospectively reviewed 13 consecutive patients with cranial base chordoma, including ten males and three females with mean age of 39.5 years (range 5-76 years).
The method of initial treatment included surgery and post-operative conventional local irradiation (IR) in 9 patients, surgery and IR followed by post-operative stereotactic radiosurgery (SRS) in 2 patients, surgery as well as SRS in one patients, and surgery as well as SRS followed by IR in one patient. Subtotal removal (over 95%) was accomplished in eight patients. The mean follow-up period after completion of surgery and initial radiotherapy was 122 months (median 108 months). According to the Kaplan-Meier estimate method, the 5-year survival rate was 82.5%: 11 out of 13 patients survived longer than 5 years and five patients survived longer than 10 years. With a longer follow-up period than the previous reports, our series has provided a 5-year survival rate comparable to that of proton beam therapy. Although our series indicates a favourable outcome, surgical resection followed by IR or SRS failed to control tumour growth in five patients.
IR and/or SRS provided results comparable with proton beam or heavy particle therapy in our series of cranial base chordomas probably because the radiation field must have covered the target of the tumour volume sufficiently, and reduction of gross tumour volume reduced the target size for radiotherapy. Pursuit of further effective combinations of IR and stereotactic radiotherapy (SRS, proton beam, heavy particle) after tangible resection, especially for residual and recurrent lesions, will be an acceptable framework to achieve a better therapeutic outcome for cranial base chordomas than at present.
本研究的目的是阐明颅底脊索瘤的最新长期治疗结果。我们通过回顾我院治疗的颅底脊索瘤以及多模态治疗时代已发表的文献，寻求改善长期治疗效果。
我们回顾性分析了13例连续的颅底脊索瘤患者，其中男性10例，女性3例，平均年龄39.5岁（范围5 - 76岁）。
初始治疗方法包括9例患者采用手术及术后常规局部放疗（IR），2例患者采用手术及IR后行术后立体定向放射外科治疗（SRS），1例患者仅行手术及SRS，1例患者行手术及SRS后行IR。8例患者实现了次全切除（超过95%）。手术和初始放疗完成后的平均随访期为122个月（中位数108个月）。根据Kaplan - Meier估计方法，5年生存率为82.5%：13例患者中有11例存活超过5年，5例患者存活超过10年。与之前的报道相比，我们的系列研究随访期更长，5年生存率与质子束治疗相当。尽管我们的系列研究显示了良好的结果，但手术切除后行IR或SRS未能控制5例患者的肿瘤生长。
在我们的颅底脊索瘤系列研究中，IR和/或SRS的结果与质子束或重粒子治疗相当，可能是因为辐射野必须充分覆盖肿瘤体积的靶区，且肿瘤总体积的减小降低了放疗的靶区大小。在切实切除肿瘤后，尤其是对于残留和复发病变，寻求IR与立体定向放疗（SRS、质子束、重粒子）的进一步有效联合，将是一个可接受的框架，以实现比目前更好的颅底脊索瘤治疗效果。
