Hayashi Yasutaka, Mizumoto Masashi, Akutsu Hiroyoshi, Takano Shingo, Matsumura Akira, Okumura Toshiyuki, Kawabe Takuya, Zenkoh Junko, Sakurai Hideyuki, Tsuboi Koji
1 Department of Radiation Oncology, Tsukuba Medical Center Hospital, Ibaraki, Japan.
2 Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Br J Radiol. 2016 Jul;89(1063):20151051. doi: 10.1259/bjr.20151051. Epub 2016 Apr 21.
To evaluate the hyperfractionated high-dose proton beam therapy (PBT) for patients with clival chordomas.
Records for 19 patients with pathologically verified clival chordomas treated with surgery followed by hyperfractionated PBT were retrospectively reviewed. The first 9 consecutive patients were treated with 77.44 cobalt gray equivalents (CGEs) in 64 fractions, and the latter 10 patients were treated with 78.4 CGE in 56 fractions.
The median follow-up period of all 19 cases was 61.7 months with a range from 31.5 to 115.4 months. At 5 years, the local control, cause-specific and overall survival rates for all 19 cases were 75%, 94% and 83.2%, respectively. Whereas the 5-year local control, cause-specific and over all survival rates of the latter 10 cases were 100%, 100% and 88.9%, respectively, with a median follow-up period of 59.5 months. One of the first nine patients demonstrated bilateral temporal lobe radiation necrosis, who were successfully treated conservatively. In the latter cohort, two cases showed transient neurological symptoms probably due to brain stem ischaemia, but both cases recovered completely with conservative treatment.
The hyperfractionated high-dose scheme combined with maximum surgical removal was shown to be efficient for patients with clival chordomas.
High-dose proton beam radiotherapy using a hyperfractionation scheme yielded a more favourable outcome than previous reports.
评估超分割大剂量质子束治疗（PBT）对斜坡脊索瘤患者的疗效。
回顾性分析19例经病理证实的斜坡脊索瘤患者的记录，这些患者接受了手术治疗，随后进行了超分割PBT。前9例连续患者接受64次分割的77.44钴灰当量（CGE）治疗，后10例患者接受56次分割的78.4 CGE治疗。
19例患者的中位随访期为61.7个月，范围为31.5至115.4个月。5年时，19例患者的局部控制率、病因特异性生存率和总生存率分别为75%、94%和83.2%。而后10例患者的5年局部控制率、病因特异性生存率和总生存率分别为100%、100%和88.9%，中位随访期为59.5个月。前9例患者中有1例出现双侧颞叶放射性坏死，经保守治疗成功治愈。在后一组中，2例出现短暂的神经症状，可能是由于脑干缺血，但均经保守治疗完全康复。
超分割大剂量方案联合最大程度的手术切除对斜坡脊索瘤患者显示出良好的疗效。
采用超分割方案的大剂量质子束放疗产生了比以往报告更有利的结果。
