Jiang Bowen, Veeravagu Anand, Feroze Abdullah H, Lee Marco, Harsh Griffith R, Soltys Scott G, Gibbs Iris C, Adler John R, Chang Steven D
Department of Neurosurgery, Stanford University School of Medicine, Stanford University, CA 94305, USA.
J Neurooncol. 2013 Sep;114(2):209-18. doi: 10.1007/s11060-013-1172-9. Epub 2013 Jun 8.
The use of CyberKnife (CK) stereotactic radiosurgery (SRS) for the management of central nervous system chondrosarcomas has not been previously reported. To evaluate outcomes of primary, recurrent, and metastatic chondrosarcomas of the skull base and spine treated with CK SRS, a retrospective observational study of 16 patients treated between 1996 and 2011 with CK SRS was performed using an IRB-approved database at Stanford University Medical Center. Twenty lesions (12 cranial, 8 spinal) across six males and ten females were analyzed. The median age at SRS was 51 years and median follow-up was 33 months. Median tumor volume was 11.0 cm³ and median marginal dosages were 22, 24, 26, 27, and 30 Gy for one to five fractionations, respectively. Overall Kaplan-Meier survival rates were 88, 88, 80, and 66 % at 1, 3, 5, and 10 years after initial presentation. Survival rates at 1, 3, and 5 years after CK were 81, 67, and 55 %, respectively. Actuarial tumor control was 41 ± 13 % at 60 months. At 36 months follow-up, tumor control was 80 % in primary lesions, 50 % in recurrent lesions, and 0.0 % in metastatic disease (p = 0.07). Tumor control was 58 % in cranial lesions and 38 % in spinal lesions. Radiation injury was reported in one patient. CK SRS appears to be a safe adjuvant therapy and offers moderate control for primary cranial chondrosarcoma lesions. There appears to be a clinically, albeit not statistically, significant trend towards poorer outcomes in similarly treated metastatic, recurrent, and spinal chondrosarcomas (p = 0.07). Lesions not candidates for single fraction SRS may be treated with hypofractionated SRS without increased risk for radiation necrosis.
此前尚未有关于使用射波刀（CK）立体定向放射外科（SRS）治疗中枢神经系统软骨肉瘤的报道。为评估经CK SRS治疗的颅底和脊柱原发性、复发性及转移性软骨肉瘤的治疗效果，我们利用斯坦福大学医学中心经机构审查委员会批准的数据库，对1996年至2011年间接受CK SRS治疗的16例患者进行了一项回顾性观察研究。分析了6例男性和10例女性患者的20个病灶（12个颅骨病灶，8个脊柱病灶）。SRS时的中位年龄为51岁，中位随访时间为33个月。中位肿瘤体积为11.0 cm³，一至五次分割照射时的中位边缘剂量分别为22、24、26、27和30 Gy。初次就诊后1、3、5和10年的总体Kaplan-Meier生存率分别为88%、88%、80%和66%。CK治疗后1、3和5年的生存率分别为81%、67%和55%。60个月时的精算肿瘤控制率为41±13%。在36个月的随访中，原发性病灶的肿瘤控制率为80%，复发性病灶为50%，转移性疾病为0.0%（p = 0.07）。颅骨病灶的肿瘤控制率为58%，脊柱病灶为38%。有1例患者报告发生了放射性损伤。CK SRS似乎是一种安全的辅助治疗方法，对原发性颅骨软骨肉瘤病灶有一定的控制效果。在接受类似治疗的转移性、复发性和脊柱软骨肉瘤中，虽然未达到统计学意义，但似乎存在临床结局较差的显著趋势（p = 0.07）。不适合单次分割SRS治疗的病灶可采用低分割SRS治疗，而不会增加放射性坏死的风险。
