Chun H C, Schmidt-Ullrich R K, Wolfson A, Tercilla O F, Sagerman R H, King G A
Department of Radiation Oncology, Medical College of Virginia, Richmond 23298.
J Neurooncol. 1990 Dec;9(3):211-7. doi: 10.1007/BF02341151.
Of 34 evaluated patients with primary spinal cord tumors, 32 were irradiated at our institutions between 1969 and 1983. The results are reported of 32 patients, 16 with ependymoma and 16 with astrocytoma, who were treated with postoperative external beam radiotherapy following biopsy or subtotal resection. Twenty-nine patients received 45-55 Gy megavoltage beam irradiation in five to six weeks, and the remaining three patients received less than 40 Gy. The minimum follow-up was five years. Five- and ten-year actuarial survival rates for the entire group of patients were 73% (22/30) and 50% (8/16), respectively, including three patients who were salvaged by surgery after radiotherapy failures. Corresponding five- and ten-year relapse-free survival rates were 60% (18/30) and 32% (6/19), respectively. Of the 29 patients who received more than 45 Gy, relapse-free survival at five years was 63% (17/27). Treatment failed in 13 patients, and all of those failures were within the irradiated portals. Patients with ependymomas have significantly better relapse free survival than those with astrocytomas, 80% vs. 40% (p less than 0.05). There was a significant difference in survival between patients with tumors involving the cervical spine and those with tumors in the other locations, 45% vs. 89% (p less than 0.05). There was no significant difference in survival between patients with cauda equina tumors and those with tumors of the spinal cord, 100% vs. 68% (p less than 0.05). No radiotherapy-related neurological deficit was noted with a maximum 20 year follow-up. This study confirms that external beam radiotherapy is a safe and effective treatment modality for primary spinal cord tumors.
在34例接受评估的原发性脊髓肿瘤患者中，1969年至1983年间有32例在我们机构接受了放疗。报告了32例患者的结果，其中16例为室管膜瘤，16例为星形细胞瘤，这些患者在活检或次全切除术后接受了术后外照射放疗。29例患者在五至六周内接受了45 - 55 Gy的兆伏级束照射，其余3例患者接受的照射剂量低于40 Gy。最短随访时间为5年。整个患者组的5年和10年精算生存率分别为73%（22/30）和50%（8/16），其中包括3例放疗失败后经手术挽救的患者。相应的5年和10年无复发生存率分别为60%（18/30）和32%（6/19）。在接受超过45 Gy照射的29例患者中，5年无复发生存率为63%（17/27）。13例患者治疗失败，所有这些失败均发生在照射野内。室管膜瘤患者的无复发生存率明显高于星形细胞瘤患者，分别为80%和40%（p<0.05）。累及颈椎的肿瘤患者与其他部位肿瘤患者的生存率存在显著差异，分别为45%和89%（p<0.05）。马尾神经肿瘤患者与脊髓肿瘤患者的生存率无显著差异，分别为100%和68%（p<0.05）。在最长20年的随访中未发现与放疗相关的神经功能缺损。本研究证实，外照射放疗是原发性脊髓肿瘤的一种安全有效的治疗方式。
