Fuller D B, Bloom J G
LDS Hospital Radiation Center, Salt Lake City, UT 84143.
Int J Radiat Oncol Biol Phys. 1988 Aug;15(2):331-9. doi: 10.1016/s0360-3016(98)90012-8.
Twenty-five patients with gross residual chordoma after partial excision or biopsy were treated by radical radiotherapy at Royal Marsden Hospital between 1952 and 1981. The median duration of freedom from local progression following radiotherapy was 32 months. Twenty-four of the 25 patients (96%) had stabilization or reduction in symptoms. All 19 patients in whom pain was a major symptom had relief. The overall actuarial 5- and 10-year survival rates were 44% and 17%, respectively. The corresponding progression--free survival rates were 33% and 20%. Permanent cure was unusual with any radiotherapy dose, but doses higher than 55 Gy or a TDF of 90 were associated with a statistically significant improvement in duration of local control. Seven of 17 (41%) patients who received greater than 55 Gy had freedom from local progression for 5 or more years compared with only 1 of 8 patients receiving less than 50 Gy. Subtotal excision prior to radiotherapy did not appear to improve median survival or probability of long-term local control. Distant metastases were seen in 16% of the patients, derived entirely from sacrococcygeal lesions, but only half of these caused significant morbidity or death. Local control is obviously the overwhelming problem. High dose, generous volume radiotherapy is advocated.
1952年至1981年间，皇家马斯登医院对25例部分切除或活检后有明显残留脊索瘤的患者进行了根治性放疗。放疗后局部无进展的中位持续时间为32个月。25例患者中有24例（96%）症状稳定或减轻。所有以疼痛为主要症状的19例患者疼痛均缓解。总体精算5年和10年生存率分别为44%和17%。相应的无进展生存率分别为33%和20%。无论放疗剂量如何，永久治愈都不常见，但剂量高于55 Gy或总剂量因子（TDF）为90与局部控制持续时间的统计学显著改善相关。17例接受超过55 Gy放疗的患者中有7例（41%）局部无进展达5年或更长时间，而接受低于50 Gy放疗的8例患者中只有1例。放疗前的次全切除似乎并未改善中位生存期或长期局部控制的概率。16%的患者出现远处转移，均来自骶尾部病变，但其中只有一半导致明显的发病率或死亡。局部控制显然是首要问题。主张采用高剂量、大体积放疗。
