Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China.
Department of Research Centre, Eye and ENT Hospital of Fudan University, Shanghai, China.
Acta Otolaryngol. 2020 Sep;140(9):789-794. doi: 10.1080/00016489.2020.1748225. Epub 2020 Aug 17.
The role of endonasal endoscopic surgery and radiotherapy in the treatment of skull base chordomas remains unclear.
We investigated the effect of endonasal endoscopic surgery and radiotherapy as treatment for skull base chordomas.
We investigated 46 patients (2006-2018) treated at the Affiliated Eye Ear Nose and Throat Hospital, Fudan University. We documented demographics, clinical presentation, operative resection, complications, postoperative radiotherapy, follow-up time, and survival in all patients.
Complete tumour resection was performed in 18 (39.1%), subtotal tumour resection in 16 (34.8%), and partial tumour resection in 12 (26.1%) patients. Most common clinical manifestations included nasal obstruction (41%), headaches (30%), and visual impairment (20%). The median duration of progression-free survival (PFS) and overall survival (OS) was 21.5 and 33.5 months, respectively. Primary vs. recurrent disease ( = .043), partial resection (PR) vs. subtotal resection (STR) ( = .006), STR vs. gross total resection (GTR) ( = .020), GTR vs. PR ( = .001), and complicated vs. uncomplicated status ( = .002) were significantly associated with PFS. Primary vs. recurrent disease ( = .002), PR vs. STR ( = .001), GTR vs. PR ( = .001), surgery alone vs. surgery concomitant with radiotherapy ( = .048), and complicated vs. uncomplicated status ( = .017) were significantly associated with OS.
Surgery is the primary treatment for chordoma; higher tumour resection rates are associated with higher OS and PFS. Surgeons should aim to resect as much tumour as is safely possible. Postoperative radiotherapy is useful adjuvant treatment to improve OS, and IMRT serves as an effective alternative to PBRT.The optimal radiotherapeutic technique is determined by cost, accessibility, availability of the modality, and tumour volume.
经鼻内镜手术和放疗在颅底脊索瘤治疗中的作用仍不明确。
研究经鼻内镜手术和放疗治疗颅底脊索瘤的效果。
研究了复旦大学附属眼耳鼻喉科医院 2006 年至 2018 年间收治的 46 例患者。记录了所有患者的人口统计学、临床表现、手术切除、并发症、术后放疗、随访时间和生存情况。
18 例（39.1%）患者行肿瘤全切除，16 例（34.8%）患者行次全切除，12 例（26.1%）患者行部分切除。最常见的临床表现包括鼻塞（41%）、头痛（30%）和视力障碍（20%）。无进展生存期（PFS）和总生存期（OS）的中位数分别为 21.5 和 33.5 个月。初发 vs. 复发（ = .043）、部分切除（PR）vs. 次全切除（STR）（ = .006）、STR vs. 大体全切除（GTR）（ = .020）、GTR vs. PR（ = .001）以及并发症 vs. 无并发症状态（ = .002）与 PFS 显著相关。初发 vs. 复发（ = .002）、PR vs. STR（ = .001）、GTR vs. PR（ = .001）、单纯手术 vs. 手术联合放疗（ = .048）以及并发症 vs. 无并发症状态（ = .017）与 OS 显著相关。
手术是脊索瘤的主要治疗方法；更高的肿瘤切除率与更高的 OS 和 PFS 相关。外科医生应尽可能安全地切除肿瘤。术后放疗是提高 OS 的有效辅助治疗方法，调强放疗（IMRT）是质子重离子放疗（PBRT）的有效替代方法。最佳放疗技术的选择取决于成本、可及性、模式可用性和肿瘤体积。
