Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
Spine (Phila Pa 1976). 2012 Jan 15;37(2):119-26. doi: 10.1097/BRS.0b013e31823d2143.
Retrospective case series.
To determine the effect of modern surgical and aggressive radiation techniques on outcome in patients with spinal chondrosarcoma.
Chondrosarcoma of the spine presents a difficult surgical challenge. Surgical excision is considered the standard of care, yet complete excision is not always feasible, and rates of local control and survival are inferior to those reported for the extremities.
We performed a retrospective review of cases of chondrosarcoma involving the spine above the sacrum treated surgically at our institution between 1984 and 2006. Medical charts, radiology reports, pathology reports, and operative notes were reviewed for all patients. Available imaging studies were also reviewed. The Student t test and Fisher exact test were used to compare baseline differences between groups. Survivorship analysis was performed using Kaplan-Meier methodology. Overall survival was calculated on the basis of en bloc resection, margins, local recurrence, and metastasis.
Twenty-one patients were treated surgically for chondrosarcoma of the mobile spine. Twenty of the 21 patients were also treated with radiation with a mean dose of 71 Gy (range, 53-83). The average overall survival for all patients in our series was 120.5 months (SE = 32.9; range, 8.5-298.9 months). The 1- and 5-year survival rates for all patients were 90% and 61%, respectively. Patients treated with en bloc resection had a better overall survival (198 months: SE = 24.5; range, 24-224.7 months) than those who underwent intralesional excision (77 months: SE = 27.3; range, 8.5-298.9 months) (P = 0.05). Five (24%) patients developed local recurrence and 9 (43%) developed metastasis. All recurrences occurred in patients who underwent intralesional resection. Metastasis, high-grade tumor, and positive surgical margins were associated with worse overall survival (P < 0.001, 0.02, and 0.04, respectively).
In this series, en bloc resection, the absence of metastasis, low-grade tumors, and negative margins were associated with improved overall survival. The aggressive use of sophisticated surgical and radiation techniques appears to confer an advantage to patients, decreasing local recurrence and increasing overall survival, even following incomplete surgical resection.
回顾性病例系列研究。
确定现代外科和积极的放射技术对脊柱软骨肉瘤患者结局的影响。
脊柱软骨肉瘤的手术治疗极具挑战性。手术切除被认为是标准的治疗方法，但并非总是可行，局部控制和生存率低于四肢报道的水平。
我们对我院 1984 年至 2006 年间手术治疗的脊柱上段脊柱软骨肉瘤病例进行了回顾性研究。对所有患者的病历、放射学报告、病理学报告和手术记录进行了回顾。还回顾了可用的影像学研究。使用 Student t 检验和 Fisher 确切检验比较组间基线差异。采用 Kaplan-Meier 方法进行生存分析。总生存率根据整块切除、切缘、局部复发和转移进行计算。
21 例患者因移动性脊柱软骨肉瘤接受手术治疗。21 例患者中有 20 例接受了放射治疗，平均剂量为 71 Gy（范围为 53-83）。我们系列研究中所有患者的平均总生存率为 120.5 个月（SE = 32.9；范围为 8.5-298.9 个月）。所有患者的 1 年和 5 年生存率分别为 90%和 61%。整块切除患者的总生存率（198 个月：SE = 24.5；范围为 24-224.7 个月）优于行部分切除术的患者（77 个月：SE = 27.3；范围为 8.5-298.9 个月）（P = 0.05）。5 例（24%）患者出现局部复发，9 例（43%）患者发生转移。所有复发均发生在接受部分切除术的患者中。局部复发、高级别肿瘤和阳性切缘与总体生存率较差相关（P < 0.001、0.02 和 0.04）。
在本系列中，整块切除、无转移、低级别肿瘤和阴性切缘与总体生存率提高相关。积极使用复杂的外科和放射技术似乎对患者有利，即使在不完全手术切除后，也能降低局部复发率并提高总体生存率。
