Castro J R, Linstadt D E, Bahary J P, Petti P L, Daftari I, Collier J M, Gutin P H, Gauger G, Phillips T L
University of California Lawrence Berkeley Laboratory, Berkeley 94720.
Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):647-55. doi: 10.1016/0360-3016(94)90550-9.
To review the experience at University of California Lawrence Berkeley Laboratory in using charged particles to irradiate primary neoplasms of the skull base and those extending to the skull base from the nasopharynx and paranasal sinuses.
During the period from 1977 to 1992, 223 patients were irradiated with charged particles at the Lawrence Berkeley Laboratory for tumors either arising in or extending to the skull base, of whom 48 (22%) had recurrent lesions, either post previous surgery or radiotherapy. One hundred twenty-six patients had lesions arising in the cranial base, mostly chordoma (53), chondrosarcoma (27), paraclival meningioma (27) with 19 patients having other histologies such as osteosarcoma or neurofibrosarcoma. There were also 31 patients with primary or recurrent squamous carcinoma of the nasopharynx extending to the skull base, 44 patients with major or minor salivary gland tumors, mostly adenocarcinoma, and 22 patients with squamous carcinoma of the paranasal sinuses, all with cranial base extension.
Local control and survival appeared improved in tumors arising in the skull base, following the ability with charged particles to deliver high doses (mean of 65 Gy-equivalent) with relative sparing of the adjacent normal tissues. The Kaplan-Meier 5-year local control was 85% for meningioma, 78% for chondrosarcoma, 63% for chordoma and 58% for other sarcoma. Follow-up ranged from 4-191 months with a median of 51 months.
Charged particle radiotherapy is highly effective in controlling cranial base lesions which have have been partially resected. Better tumor localization with CT and MRI, improved 3-D treatment planning and beam delivery techniques have continued to reduce the level of serious complications and increase local control and survival.
回顾加利福尼亚大学劳伦斯伯克利实验室使用带电粒子照射颅底原发性肿瘤以及从鼻咽部和鼻窦延伸至颅底的肿瘤的经验。
在1977年至1992年期间，劳伦斯伯克利实验室对223例因颅底肿瘤或肿瘤延伸至颅底而接受带电粒子照射的患者进行了研究，其中48例（22%）为既往手术或放疗后的复发病变。126例患者的病变起源于颅底，主要为脊索瘤（53例）、软骨肉瘤（27例）、斜坡旁脑膜瘤（27例），另有19例患者具有其他组织学类型，如骨肉瘤或神经纤维肉瘤。此外，有31例鼻咽部原发性或复发性鳞状细胞癌延伸至颅底，44例大小唾液腺肿瘤患者，主要为腺癌，22例鼻窦鳞状细胞癌患者，均有颅底侵犯。
由于带电粒子能够在相对 sparing 邻近正常组织的情况下给予高剂量（平均等效剂量65 Gy），颅底起源的肿瘤的局部控制和生存率似乎有所提高。卡普兰 - 迈耶法计算的5年局部控制率，脑膜瘤为85%，软骨肉瘤为78%，脊索瘤为63%，其他肉瘤为58%。随访时间为4至191个月，中位随访时间为51个月。
带电粒子放射治疗在控制已部分切除的颅底病变方面非常有效。CT和MRI更好的肿瘤定位、改进的三维治疗计划和射束递送技术持续降低了严重并发症的发生率，并提高了局部控制率和生存率。
