Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32206, USA.
Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1463-71. doi: 10.1016/j.ijrobp.2009.03.042. Epub 2009 Jul 23.
To perform a review of the 40-year University of Florida experience treating spinal and paraspinal Ewing tumors.
A total of 27 patients were treated between 1965 and 2007. For local management, 21 patients were treated with radiotherapy (RT) alone and 6 with surgery plus RT. All patients with metastatic disease were treated with RT alone. The risk profiles of each group were otherwise similar. The median age was 17 years, and the most frequent subsite was the sacral spine (n = 9). The median potential follow-up was 16 years.
The 5-year actuarial overall survival, cause-specific survival, and local control rate was 62%, 62%, and 90%, respectively. For the nonmetastatic subset (n = 22), the 5-year overall survival, cause-specific survival, and local control rate was 71%, 71%, and 89%, respectively. The local control rate was 84% for patients treated with RT alone vs. 100% for those treated with surgery plus RT. Patients who were >14 years old and those who were treated with intensive therapy demonstrated superior local control. Of 9 patients in our series with Frankel C or greater neurologic deficits at presentation, 7 experienced a full recovery with treatment. Of the 27 patients, 37% experienced Common Toxicity Criteria Grade 3 or greater toxicity, including 2 deaths from sepsis.
Aggressive management of spinal and paraspinal Ewing tumors with RT with or without surgery results in high toxicity but excellent local control and neurologic outcomes. Efforts should be focused on identifying disease amenable to combined modality local therapy and improving RT techniques.
回顾佛罗里达大学 40 年来治疗脊柱和脊柱旁尤文氏瘤的经验。
1965 年至 2007 年间共治疗了 27 例患者。局部治疗方面，21 例患者接受单纯放疗（RT），6 例患者接受手术加 RT。所有转移性疾病患者均接受单纯 RT 治疗。两组患者的风险状况相似。中位年龄为 17 岁，最常见的部位是骶骨脊柱（n=9）。中位潜在随访时间为 16 年。
5 年总生存率、无病生存率和局部控制率分别为 62%、62%和 90%。对于非转移性亚组（n=22），5 年总生存率、无病生存率和局部控制率分别为 71%、71%和 89%。单纯 RT 治疗患者的局部控制率为 84%，手术加 RT 治疗患者的局部控制率为 100%。年龄>14 岁和接受强化治疗的患者局部控制效果更好。在我们的系列研究中，有 9 例患者在就诊时存在 Frankel C 级或更高级别的神经功能缺损，其中 7 例经治疗后完全恢复。27 例患者中有 37%出现 3 级或更高级别的常见毒性标准毒性，包括 2 例败血症死亡。
采用 RT 联合或不联合手术积极治疗脊柱和脊柱旁尤文氏瘤，毒性大，但局部控制和神经功能结局良好。应努力确定适合联合局部治疗的疾病，并改进 RT 技术。
