Muthukumar N, Kondziolka D, Lunsford L D, Flickinger J C
Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, PA 15213-2582, USA.
Int J Radiat Oncol Biol Phys. 1998 May 1;41(2):387-92. doi: 10.1016/s0360-3016(98)00051-0.
Skull base chordomas and chondrosarcomas pose management challenges owing to their critical location, locally aggressive nature, and high recurrence rate despite multimodality treatment. We used stereotactic radiosurgery as primary or adjuvant therapy to achieve safe and effective therapeutic irradiation.
At an average of 4 years (range 1-7), we evaluated 15 patients (nine with chordomas and six with chondrosarcomas) who had gamma-knife radiosurgery as an adjunct (13 patients) or as an alternative to microsurgical resection (two patients). Patient age varied from 7 to 70 years (mean 38). There was a distinct male preponderance (2:1). Thirteen patients had undergone between one and four resections. Using conformal radiosurgical planning, a maximum tumor dose of 24-40 Gy (mean 36) and a tumor margin dose of 12-20 Gy (mean 18) was given to a mean tumor volume of 4.6 ml.
Eight patients showed clinical improvement, three remained stable, and four died. Two of the four patients who died had tumor progression remote from the radiosurgery volume; two patients died of unrelated disorders. Among 11 surviving patients, follow-up imaging showed a reduction in tumor size in five, no further tumor growth in five, and an increase in the size of the tumor in one. The patient with further tumor growth after radiosurgery subsequently underwent repeat resection.
Despite the formidable management challenge posed by these neoplasms, our long-term evaluation has shown that radiosurgery is a safe and effective treatment for patients with small volume tumors.
颅底脊索瘤和软骨肉瘤因其关键位置、局部侵袭性本质以及尽管采用多模式治疗但复发率高，给治疗带来了挑战。我们采用立体定向放射外科作为主要或辅助治疗手段，以实现安全有效的治疗性照射。
平均4年（范围1 - 7年），我们评估了15例患者（9例脊索瘤和6例软骨肉瘤），他们接受了伽玛刀放射外科治疗，其中13例作为辅助治疗，2例作为显微手术切除的替代治疗。患者年龄从7岁至70岁不等（平均38岁）。男性明显居多（2:1）。13例患者曾接受过1至4次手术切除。采用适形放射外科计划，给予平均肿瘤体积4.6毫升的最大肿瘤剂量24 - 40 Gy（平均36 Gy）和肿瘤边缘剂量12 - 20 Gy（平均18 Gy）。
8例患者显示临床改善，3例病情稳定，4例死亡。4例死亡患者中有2例在放射外科治疗区域外出现肿瘤进展；2例患者死于无关疾病。在11例存活患者中，随访影像学检查显示5例肿瘤大小缩小，5例肿瘤无进一步生长，1例肿瘤大小增加。放射外科治疗后肿瘤进一步生长的患者随后接受了再次切除。
尽管这些肿瘤给治疗带来了巨大挑战，但我们的长期评估表明，放射外科对于小体积肿瘤患者是一种安全有效的治疗方法。
