Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
Spine (Phila Pa 1976). 2013 Jul 1;38(15):E930-6. doi: 10.1097/BRS.0b013e318296e7d7.
A retrospective review.
The purpose of this study is to report the results of high-dose proton based definitive radiotherapy for unresected spinal chordomas.
Spine chordoma is treated primarily by surgical resection. However, local recurrence rate is high. Adjuvant radiotherapy improves local control. In certain locations, such as high sacrum, resection may result in significant neurological dysfunction.
We retrospectively reviewed 24 patients with newly diagnosed, previously untreated spinal chordomas (core biopsy only; no prior incision or resection) treated with high-dose definitive radiotherapy alone using protons and photons at our center from 1988 to 2009.
Reasons for radiotherapy alone included medical inoperability (3) and concern for neurological dysfunction based on spine level (21). Median age was 69.5 years. Tumor locations included cervical (2), thoracic (1), lumbar (2), S1-S2 (17), and S3 or below (2). Median maximal tumor diameter was 6.6 cm (1.4-25.5), and median tumor volume was 198.3 cm (4.65-2061). Median total dose was 77.4 GyRBE (proton dose unit, gray relative biological effectiveness). Analysis at median follow-up of 56 months showed overall survival of 91.7% and 78.1%, chordoma specific survival of 95.7% and 81.5%, local progression free survival of 90.4% and 79.8% and metastases free survival of 86.5% and 76.3%, at 3 and 5 years respectively. Tumor volume more than 500 cm was correlated with worse overall survival. Long-term side effects included 8 sacral insufficiency fractures (none required surgical stabilization), 1 secondary malignancy, 1 foot drop, 1 erectile dysfunction, 1 perineal numbness, 2 worsening urinary/fecal incontinence, and 4 grade-2 rectal bleeding. None required new colostomy. All surviving patients remained ambulatory.
These results support the use of high-dose definitive radiotherapy for patients with medically inoperable or otherwise unresected, mobile spine or sacrococcygeal chordomas.
回顾性研究。
本研究旨在报告未切除的脊髓脊索瘤采用高剂量质子根治性放疗的结果。
脊柱脊索瘤主要通过手术切除治疗。然而，局部复发率较高。辅助放疗可改善局部控制。在某些部位，如高位骶骨，切除可能导致严重的神经功能障碍。
我们回顾性分析了 2009 年以前在我们中心接受单纯高剂量根治性放疗的 24 例新诊断、未经治疗的脊柱脊索瘤患者（仅行核心活检，无先前切口或切除），这些患者使用质子和光子。
单纯放疗的原因包括手术不耐受（3 例）和基于脊柱水平的神经功能障碍（21 例）。中位年龄为 69.5 岁。肿瘤部位包括颈椎（2 例）、胸椎（1 例）、腰椎（2 例）、S1-S2（17 例）和 S3 或以下（2 例）。最大肿瘤直径的中位数为 6.6cm（1.4-25.5），肿瘤体积中位数为 198.3cm（4.65-2061）。中位总剂量为 77.4GyRBE（质子剂量单位，格雷相对生物效应）。中位随访 56 个月时的分析显示，3 年和 5 年的总生存率分别为 91.7%和 78.1%，脊索瘤特异性生存率分别为 95.7%和 81.5%，局部无进展生存率分别为 90.4%和 79.8%，无转移生存率分别为 86.5%和 76.3%。肿瘤体积大于 500cm3 与总生存率降低相关。长期副作用包括 8 例骶骨不稳定性骨折（均无需手术固定）、1 例继发恶性肿瘤、1 例足下垂、1 例勃起功能障碍、1 例会阴麻木、2 例尿便失禁加重和 4 例 2 级直肠出血。均无需新造口术。所有存活患者仍能行走。
这些结果支持对手术无法切除或其他无法切除的可移动脊柱或骶尾部脊索瘤患者采用高剂量根治性放疗。
