Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK.
Clin Oncol (R Coll Radiol). 2018 Apr;30(4):243-253. doi: 10.1016/j.clon.2018.01.002.
To evaluate the long-term outcomes of patients with chordoma and low-grade chondrosarcoma after surgery and high-dose radiotherapy.
High-dose photon radiotherapy was delivered to 28 patients at the Neuro-oncology Unit at Addenbrooke's Hospital (Cambridge, UK) between 1996 and 2016. Twenty-four patients were treated with curative intent, 17 with chordoma, seven with low-grade chondrosarcoma, with a median dose of 65 Gy (range 65-70 Gy). Local control and survival rates were calculated using the Kaplan-Meier method.
The median follow-up was 83 months (range 7-205 months). The 5 year disease-specific survival for chordoma patients treated with radical intent was 85%; the local control rate was 74%. The 5 year disease-specific survival for chondrosarcoma patients treated with radical intent was 100%; the local control rate was 83%. The mean planning target volume (PTV) was 274.6 ml (median 124.7 ml). A PTV of 110 ml or less was a good predictor of local control, with 100% sensitivity and 63% specificity. For patients treated with radical intent, this threshold of 110 ml or less for the PTV revealed a statistically significant difference when comparing local control with disease recurrence (P = 0.019, Fisher's exact test). Our data also suggest that the probability of disease control may be partly related to both target volume and radiotherapy dose.
Our results show that refined high-dose photon radiotherapy, following tumour resection by a specialist surgical team, is effective in the long-term control of chordoma and low-grade chondrosarcoma, even in the presence of metal reconstruction. The results presented here will provide a useful source for comparison between high-dose photon therapy and proton beam therapy in a UK setting, in order to establish best practice for the management of chordoma and low-grade chondrosarcoma.
评估手术和大剂量放疗后脊索瘤和低度软骨肉瘤患者的长期预后。
1996 年至 2016 年期间，在英国剑桥阿登布鲁克医院神经肿瘤科，对 28 名患者进行了高剂量光子放疗。24 名患者接受根治性治疗，17 名患有脊索瘤，7 名患有低度软骨肉瘤，中位剂量为 65 Gy（范围 65-70 Gy）。使用 Kaplan-Meier 法计算局部控制率和生存率。
中位随访时间为 83 个月（范围 7-205 个月）。根治性治疗的脊索瘤患者 5 年疾病特异性生存率为 85%；局部控制率为 74%。根治性治疗的软骨肉瘤患者 5 年疾病特异性生存率为 100%；局部控制率为 83%。平均计划靶区（PTV）为 274.6 ml（中位数 124.7 ml）。PTV 为 110 ml 或更小是局部控制的良好预测指标，敏感性为 100%，特异性为 63%。对于接受根治性治疗的患者，PTV 小于或等于 110 ml 与疾病复发时的局部控制相比具有统计学显著差异（P = 0.019，Fisher 精确检验）。我们的数据还表明，疾病控制的可能性可能部分与靶区体积和放疗剂量有关。
我们的结果表明，在专业外科团队切除肿瘤后，采用精细的高剂量光子放疗对脊索瘤和低度软骨肉瘤的长期控制是有效的，即使存在金属重建也是如此。这里呈现的结果将为英国高剂量光子放疗与质子束放疗之间的比较提供有用的资料，以便为脊索瘤和低度软骨肉瘤的治疗建立最佳实践。
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