Lockney Dennis T, Shub Timothy, Hopkins Benjamin, Lockney Natalie A, Moussazadeh Nelson, Lis Eric, Yamada Yoshiya, Schmitt Adam M, Higginson Daniel S, Laufer Ilya, Bilsky Mark
1Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
3Radiation Oncology, and.
Neurosurg Focus. 2017 Jan;42(1):E4. doi: 10.3171/2016.9.FOCUS16373.
OBJECTIVE Chordoma is a rare malignant tumor for which en bloc resection with wide margins is advocated as primary treatment. Unfortunately, due to anatomical constraints, en bloc resection to achieve wide or marginal margins is not feasible for many patients as the resulting morbidity would be prohibitive. The objective of this study was to evaluate the efficacy of intralesional curettage and separation surgery followed by spinal stereotactic body radiation therapy (SBRT) in patients with chordomas in the mobile spine. METHODS The authors performed a retrospective chart review of all patients with chordoma in the mobile spine treated from 2004 to 2016. Patients were identified from a prospectively collected database. Initially 22 patients were identified with mobile spine chordomas. With inclusion criteria of cytoreductive separation surgery followed closely by SBRT and a minimum of 6 months of follow-up imaging, 12 patients were included. Clinical and pathological characteristics of each patient were collected and data were analyzed. Patients were divided into two cohorts-those undergoing intralesional resection followed by SBRT as initial chordoma treatment at Memorial Sloan Kettering Cancer Center (MSKCC) (Cohort 1) and those undergoing salvage treatment following recurrence (Cohort 2). Treatment toxicities were classified according to the Common Terminology Criteria for Adverse Events version 4.03. Overall survival was analyzed using Kaplan-Meier analysis. RESULTS The 12 patients had a median post-SBRT follow-up time of 26 months. Cohort 1 had 5 patients with median post-SBRT follow-up time of 65.9 months and local control rate of 80% at last follow-up. Only one patient had disease progression, at 48.2 months following surgery and SBRT. Cohort 2 had 7 patients who had been treated at other institutions prior to undergoing both surgery and SBRT (salvage therapy) at MSKCC. The local control rate was 57.1% and the median follow-up duration was 10.7 months. One patient required repeat irradiation. Major surgery- and radiation-related complications occurred in 18% and 27% of patients, respectively. Epidural spinal cord compression scores were collected for each patient pre- and postoperatively. CONCLUSIONS The combination of surgery and SBRT provides excellent local control following intralesional curettage and separation surgery for chordomas in the mobile spine. Patients who underwent intralesional curettage and spinal SBRT as initial treatment had better disease control than those undergoing salvage therapy. High-dose radiotherapy may offer several biological benefits for tumor control.
目的 脊索瘤是一种罕见的恶性肿瘤，主张将广泛边缘的整块切除作为主要治疗方法。不幸的是，由于解剖学限制，对许多患者来说，实现广泛或边缘性边缘的整块切除是不可行的，因为由此产生的发病率将过高。本研究的目的是评估在活动脊柱脊索瘤患者中，病灶内刮除和分离手术联合脊柱立体定向体部放射治疗（SBRT）的疗效。方法 作者对2004年至2016年治疗的所有活动脊柱脊索瘤患者进行了回顾性病历审查。患者从一个前瞻性收集的数据库中识别出来。最初识别出22例活动脊柱脊索瘤患者。纳入标准为减瘤分离手术后紧接着进行SBRT且至少有6个月的随访影像学检查，共纳入12例患者。收集每位患者的临床和病理特征并进行数据分析。患者分为两个队列——在纪念斯隆凯特琳癌症中心（MSKCC）接受病灶内切除后紧接着进行SBRT作为初始脊索瘤治疗的患者（队列1）和复发后接受挽救治疗的患者（队列2）。根据不良事件通用术语标准第4.03版对治疗毒性进行分类。使用Kaplan-Meier分析评估总生存期。结果 12例患者SBRT后的中位随访时间为26个月。队列1有5例患者，SBRT后的中位随访时间为65.9个月，最后一次随访时局部控制率为80%。仅1例患者在手术和SBRT后48.2个月出现疾病进展。队列2有7例患者，在MSKCC接受手术和SBRT（挽救治疗）之前曾在其他机构接受过治疗。局部控制率为57.1%，中位随访时间为10.7个月。1例患者需要重复放疗。主要的手术和放疗相关并发症分别发生在18%和27%的患者中。收集每位患者术前和术后的硬膜外脊髓压迫评分。结论 手术和SBRT联合应用在活动脊柱脊索瘤病灶内刮除和分离手术后能提供出色的局部控制。作为初始治疗接受病灶内刮除和脊柱SBRT的患者比接受挽救治疗的患者疾病控制更好。高剂量放疗可能为肿瘤控制带来多种生物学益处。
