1Department of Spine Surgery, Orthopaedic Institute Rizzoli, Bologna, Italy.
2University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland.
J Neurosurg Spine. 2024 Sep 27;41(6):708-715. doi: 10.3171/2024.5.SPINE231401. Print 2024 Dec 1.
The aim of this study was to compare the outcome of intralesional gross-total resection (GTR) followed by high-energy particle therapy with en bloc and intralesional resections.
A retrospective study of patients diagnosed with primary osteogenic sarcoma (OGS) of the spine between 2009 and 2020 was conducted. Demographic information, including age, affected site, tumor volume, and Weinstein-Boriani-Biagini stage, was collected. Additionally, information on metastases at diagnosis, length of stay, operating time, complications, planned surgical treatment, and radiotherapy was also collected. Outcome measures, including local recurrence (LR) and disease-specific survival (DSS), were compared using Kaplan-Meier curves.
In total, 20 patients with a median age of 38 (IQR 23-60) years were included. The median follow-up was 15.7 (IQR 6.3-36.9) months. Eight patients underwent en bloc resection with a 38% (3 patients) LR rate and a median DSS of 26.4 months. Four patients received adjuvant high-energy particle therapy after planned GTR. Their median follow-up was 36 months; none of these patients experienced LR. Both the 1-year and 3-year DSSs were 100%. Another 8 patients underwent intralesional resection. Six of the 8 patients (75%) died of their disease, with a median survival of 7.3 (IQR 4.7-14) months.
GTR combined with adjuvant high-energy particle therapy appears to be a safe and effective alternative approach for patients with OGS of the spine when en bloc resection is not feasible. The results demonstrated a 3-year DSS of 100% and no major surgical complications.
本研究旨在比较肿瘤整块切除术（en bloc resection）与肿瘤部分切除术（intralesional resection）后行大剂量粒子放疗，对内生型骨肉瘤（osteogenic sarcoma，OSG）患者的治疗效果。
回顾性分析了 2009 年至 2020 年间被诊断为脊柱原发性骨肉瘤的患者。收集了患者的一般资料，包括年龄、发病部位、肿瘤体积和 Weinstein-Boriani-Biagini 分期。此外，还收集了患者的诊断时转移情况、住院时间、手术时间、并发症、手术和放疗计划等信息。采用 Kaplan-Meier 曲线比较局部复发率（local recurrence，LR）和疾病特异性生存率（disease-specific survival，DSS）。
共纳入 20 例患者，中位年龄为 38 岁（IQR 23-60）。中位随访时间为 15.7 个月（IQR 6.3-36.9）。8 例行肿瘤整块切除术，LR 率为 38%（3 例），中位 DSS 为 26.4 个月。4 例行计划行肿瘤整块切除术（gross-total resection，GTR）后接受辅助大剂量粒子放疗。中位随访时间为 36 个月，无 LR 发生。1 年和 3 年 DSS 均为 100%。另 8 例行肿瘤部分切除术。8 例中有 6 例（75%）患者死于该疾病，中位生存期为 7.3 个月（IQR 4.7-14）。
对于无法行肿瘤整块切除术的脊柱内生型骨肉瘤患者，GTR 联合辅助大剂量粒子放疗似乎是一种安全有效的治疗方法。本研究中，患者 3 年 DSS 为 100%，无重大手术并发症。
