37例颅底部脊索瘤的治疗与预后

目的探讨颅底部脊索瘤的临床特点、治疗方法和预后。方法有病理诊断的颅底部脊索瘤37例,手术加放射治疗28例,单纯放疗8例,单纯手术1例。放射治疗总剂量为30～75Gy,中位剂量为60Gy。结果全组患者治疗结束时症状缓解率和病灶明显消退或消失率分别为86．5％和48．6％;疗后6个月至2年,部分病例神经和内分泌损伤得到恢复。全组1,3,5,10年总生存率分别为97．3％、87．3％、71．5％和41．0％。前组颅神经损伤的1,3,5,10年生存率分别为100．0％、92．9％、85．7％和50．8％;后组分别为1130．0％、75．0％、45．0％和0,差异有统计学意义（P=0．04）。结论脊索瘤的治疗以手术为首选。由于解剖部位特殊,手术难以彻底切除,局部治疗失败是死亡的主要原因。放射治疗对于缓解症状、控制局部病灶具有重要作用。根治术后预防照射剂量应不低于60Gy,术后残留病灶、复发和未手术者照射剂量应达70Gy或更高。后组颅神经受损提示预后不良。     

鼻咽脊索瘤7 例临床分析

 目的　探讨鼻咽脊索瘤的诊断方法及治疗方案。方法　回顾性分析 7例鼻咽脊索瘤的临床特征、误诊情况、治疗方法及随访结果。结果　 ( 1 ) 7例中 6例被 CT及临床医师误诊为鼻咽癌 ;误诊率均为 87.1 % ( 6/7)。 ( 2 )全组 5年生存率 71 % ( 5/7) ,5年无瘤生存率 57% ( 4 /7)。结论　( 1 )鼻咽脊索瘤易误诊为鼻咽癌。 ( 2 )手术切除加术后放疗是最佳治疗方法.     

59例骶尾部脊索瘤术后放疗后的生存分析

目的：明确骶尾部脊索瘤患者是否能从术后的辅助放疗中获益，并且探索恰当的术后放疗模式。方法：回顾性纳入59例无远处转移且病理诊断明确为骶尾部脊索瘤的患者，分析其术后辅助放疗的生存情况。患者分为3组：22例为单纯手术切除组，24例为手术联合术后图像引导下调强放疗（IG-IMRT）治疗组，13例为手术联合伽马刀（GKS）治疗组。结果：所有患者的5年生存率及5年无复发生存率分别为80.1%和44.5%；单纯手术组、IG-IMRT组及GKS组5年生存率分别为90.9%、87.5%及59.3%，5年无复发生存率分别为29.8%、70.9%和35%；术后辅助放疗组对比单纯手术组的5年无复发生存率差异具有统计学意义（P=0.029），IG-IMRT组的5年无复发生存率优于GKS组（P=0.023）。结论：术后辅助放疗有助于提升脊索瘤术后患者的5年无复发生存率，且术后辅助IG-IMRT可能是更为恰当的术后放疗模式。     

脊索瘤的放射治疗：附10例报告

脊索瘤少见,1976年6月~1992年6月间,我科收治10例,9例经病理证实,1例根据病史及影像学检查诊断.现报告如下:本组男8例,女2例,年龄38岁~67岁,中位年龄52岁.病灶位于颅底3例,均有头痛,2例视力下降伴内斜视,1例失明.骶尾部7例,均有局部疼痛,其中疼痛向下肢放射1例,排便障碍3例,伴阳萎2例.自症状出现到确诊2月~6年,中位时间2.5年.手术加术后放疗5例,其中1例初治5年后复发再放疗1程.单纯放疗3例,单纯手术1例;术后一年半因复发放疗1例.采用~60 钴外照射,源皮距75cm,骶尾部均设单野垂直照射.颅底脊索瘤则根据病变     

脊索瘤综合治疗的意义

脊索瘤较少见 ,治疗以手术或手术加放疗为主 ,但易复发 ,5年生存率 75%～ 83% ,1 0年生存率42 %～ 50 % [1] 。我科于 1 975年 5月～ 1 992年 5月收治 4例 ,报道如下。1　材料和方法本组 4例均为男性 ,年龄 37～ 71岁 ,中位年龄41岁。肿瘤位于鞍区 2例 ,骶骨 1例 ,第 5腰椎 (L5)1例。作过一次手术 2例 ,二次手术 2例 (其中 1例为再复发病例 )。 4例术后均采用 60 Co外照射 ,DT55～ 65Gy,每日 1次 ,每次 DT2 Gy,每周 5次。其中1例放疗后 6年复发 ,再程放疗采用 6mv X线照射 ,DT60 Gy,常规分割照射。2　结　果本组 4例中 2例肿瘤位于鞍区…     

骶尾部脊索瘤的诊断与外科治疗

目的回顾性分析骶尾部脊索瘤的诊断与外科治疗体会。方法收集本院经病理证实的骶尾部脊索瘤18例，分析其临床特征和诊疗结果。结果18例手术时中位年龄为44岁(24～73岁)；男性11例，女性7例，其中第2次手术者3例；肿瘤体积大小为16～126ml，平均45．6ml；病理分期Ⅰa期1例．Ⅰb期16例，Ⅲ期1例；肿瘤位于L5 1例、S1 3例、S2 3例,S3以下11例。手术采用后方入路11例，前后路联合切除7例。行瘤内切除11例，边缘性切除5例，根治性切除1例，1例因术中大出血而仅行大部分切除。3例复发者及12例初发者接受^60Co45-60Gy，其中5例加11MeV电子束。并发踝关节无力3例，尿失禁或尿潴留5例。随访14个月～13年，平均3．8年。复发6例，主要在术后3年，1例于术后11年复发死亡，1例发生肺转移，另有1例于二次术后1年出现直肠周围多个类圆形软组织阴影。本组病例3年生存率77．8％(14／18)，无复发生存率38．9％(7／18)，5年生存率61．1％(11／18)。结论骶尾部脊索瘤治疗效果依赖于肿瘤部位、手术切除程度和辅助放疗。     

骶骨脊索瘤的临床病理分析

为了探讨骶骨脊索瘤的临床特点、外科治疗方法与疗效,回顾性分析接受手术治疗的26例骶骨脊索瘤患者的临床资料。26例患者均无术中死亡,术后平均随访3.5年,7例患者局部复发,局部复发率26.9%,肺转移1例,死亡2例,术后病理检查可见典型的"Physaliphorous"细胞。初步研究结果提示,骶骨脊索瘤早期症状不典型,诊断应重视CT和MR检查。广泛手术切除是有效的治疗方式,结合术中化疗和术后局部辅助放疗可降低肿瘤的局部复发率,延长生存期,提高患者的生活质量。     

骶尾部脊索瘤16例放疗随访5年疗效观察

目的　探讨放疗在骶尾部脊索瘤临床治疗中的作用。方法　采用常规分段治疗。第—段DT40Gy/ 2 0次 /4周 ,休 2周 ;第二段DT3 0GY / 15次 / 3周。随访 5年。结果　 16例骶尾部脊索瘤术后放疗或单纯性姑息放疗 ,不仅可使术后复发明显减少 (本组术后放疗复发率为 15 .3 8% ) ,而且使术后遗留症状得到改善 ,甚至消失。大剂量分段放疗的患者均未发生放射性损伤。结论　手术后放疗或单纯姑息性放疗能有效控制瘤体生长 ,延长生存期。文献提出脊索瘤对放射线不敏感的说法是否准确值得进一步探讨。     

21例骶尾部脊索瘤临床分析

目的：探讨骶尾部脊索瘤的临床特点及治疗方法。方法：回顾性分析天津医科大学附属肿瘤医院1989年1月至2004年12月收治的21例骶尾部脊索瘤患者的临床资料，11例接受单纯手术治疗，10例接受手术＋术后放疗，放射治疗剂量为40～50Gy。结果：9例患者死亡，6例死于局部复发，1例死于双肺转移，2例死于非肿瘤相关疾病。全组1、3、5、10年生存率分别为100％、95％、85％、41％。单纯手术组的5年生存率为81％，手术＋术后放疗组的5年生存率为89％，二者无显著性差异（P=0．256〉0．05）。局部复发15例，单纯手术组9例，局部复发率为81．8％，手术＋放疗组6例，局部复发率为60％，二者无显著性差异（x^2=1．222，P=0．269〉0．05）。单纯手术组局部复发时间为术后2个月-38个月，中位复发时间22个月；手术＋放疗组发生复发时间为术后23个月～个72月，中位复发时间48个月。结论：脊索瘤极易复发，患者就诊状态及治疗手段可能为影响复发的因素，手术切除为其主要治疗手段，术后辅以放疗未能明显提高生存率及减少局部复发，但推迟了局部复发时间。     

骶尾部脊索瘤11例的临床特征与治疗

目的：探讨骶尾部脊索瘤的临床特征与治疗方案。方法：分析１１例脊索瘤的临床表现、Ｘ线与病理组织学资料,总结诊治要点。结果：术后全组五年生存率为４５．５％,根治切除组为５５．６％。结论：手术切除加术后放疗为最佳治疗方法。     

Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base

PURPOSE: To investigate the treatment outcome of patients suffering from skull base chordoma or chondrosarcoma after fractionated stereotactic radiotherapy. METHODS AND MATERIALS: We report 45 patients treated for chordoma or chondrosarcoma with postoperative fractionated stereotactic radiotherapy between 1990 and 1997. Patients had CT and MRI for 3D treatment planning performed under stereotactic guidance. Median dose at isocenter was 66.6 Gy for chordomas and 64.9 Gy for chondrosarcomas. MRI imaging was obtained in intervals after therapy to evaluate local relapse. Survival was calculated according to the Kaplan-Meier method. RESULTS: All chondrosarcomas had achieved and maintained local control and recurrence-free status at follow-up of 5 years. Local control rate of chordomas was 82% at 2 years and 50% at 5 years. Survival was 97% at 2 years and 82% at 5 years. At maximum follow-up of 8 years local control and survival rate of chordomas was 40% (82%). Clinically significant late toxicity developed in one patient. CONCLUSIONS: Our results demonstrate the feasibility of fractionated photon beam therapy and its success in the treatment of skull base tumors. Modern 3D treatment techniques provide superior results compared to conventional techniques. The role of high-precision radiotherapy compared to particle beam therapy in the treatment of these tumors is not yet fully clear and further research is needed.     

Radiotherapy for chordomas and low-grade chondrosarcomas of the skull base with carbon ions

PURPOSE: Compared to photon irradiation, carbon ions provide physical and biologic advantages that may be exploited in chordomas and chondrosarcomas. METHODS AND MATERIALS: Between August 1998 and December 2000, 37 patients with chordomas (n = 24) and chondrosarcomas (n = 13) were treated with carbon ion radiotherapy within a Phase I/II trial. Tumor conformal application of carbon ion beams was realized by intensity-controlled raster scanning with pulse-to-pulse energy variation. Three-dimensional treatment planning included biologic plan optimization. The median tumor dose was 60 GyE (GyE = Gy x relative biologic effectiveness). RESULTS: The mean follow-up was 13 months. The local control rate after 1 and 2 years was 96% and 90%, respectively. We observed 2 recurrences outside the gross tumor volume in patients with chordomas. Progression-free survival was 100% for chondrosarcomas and 83% for chordomas at 2 years. Partial remission after carbon ion radiotherapy was observed in 6 patients. Treatment toxicity was mild. CONCLUSION: These are the first data demonstrating the clinical feasibility, safety, and effectiveness of scanning beam delivery of ion beams in patients with skull base tumors. The preliminary results in patients with skull base chordomas and low-grade chondrosarcomas are encouraging, although the follow-up was too short to draw definite conclusions concerning outcome. In the absence of major toxicity, dose escalation might be considered.     

Effects of different combinations of comprehensive treatment on survival of patients with locally advanced head and neck squamous cell carcinoma:post-hoc analysis of a phase Ⅲ randomized controlled clinical trial

Objective To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Methods From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m² every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan-Meier method. ResultsThe median follow-up time was 59 months (7-139 months). All patients were divided into four groups:radiotherapy group (R group,n=84), concurrent chemo-radiotherapy group (R+C group, n=67), preoperative radiotherapy group (R+S group, n=34) and preoperative concurrent chemoradiotherapy group (R+C+S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+C+S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+C Group vs. R group, P=0.081;R+C+S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+C group vs. R+S group, P=0.064;R+C group vs. R+S group, P=0.016). Conclusions Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.     

下咽鳞癌不同治疗方案的临床分析

目的　探讨不同的治疗方案治疗下咽鳞癌的疗效 ,提出规范化的治疗方案。方法　回顾性分析 4 6 4例下咽鳞癌患者的临床特征和不同治疗方案的治疗结果 ,运用SPSS 10 .0软件包进行统计分析。结果　术前放疗 +手术 2 0 2例 ,手术 +术后放疗 2 2例 ,单纯手术 2 6例 ,根治性放疗失败挽救性手术 4 0例 ,单纯放疗 174例。总的 5年生存率为 34.2 % ,术前放疗 +手术组、手术 +术后放疗组、单纯手术组、根治性放疗失败挽救性手术组及单纯放疗组 5年生存率分别为 4 6 .3%、4 9.2 %、2 2 .8%、4 0 .8%和 18.0 % (P <0 .0 1)。术前放疗 +手术组与单纯手术组比较 ,生存率差异有统计学意义 (P =0 .0 4 6 )。术前放疗 +手术组喉功能保留者 80例 ,占 39.6 % ;手术 +术后放疗和单纯手术组喉功能保留者 8例 ,占 16 .7% ,差异有统计学意义 (P =0 .0 0 3)。单纯放疗组和术前放疗 +手术组死于局部复发分别为 2 7.6 %和 8.9% (P =0 .0 0 8)。结论　下咽鳞癌患者首先应选择术前放疗 +手术或手术 +术后放疗的综合治疗方案 ,术前放疗 +手术能明显提高下咽鳞癌的喉功能保留率。     

舌体鳞状细胞癌不同治疗模式疗效分析

目的 探讨舌体鳞癌患者不同治疗模式的治疗效果。方法 回顾分析2003—2011年间在本院首治的经病理确诊且随访资料完整的舌体鳞癌患者 132例临床资料。Kaplan-Meier法计算单纯手术(S)、单纯放疗(R)、手术+放疗(S+R)、化疗+手术(C+S)、化疗+放疗(C+R)、手术+放疗+化疗(S+R+C)各组OS,组间差异采用Logrank法检验。Cox回归模型多因素预后分析确立有影响的治疗模式。结果 3年随访率为100%。3年样本数为 94例。全组患者 3年OS为72.7%。单因素分析显示 70例Ⅰ+Ⅱ期患者中S、R、S+R、C+S、S+R+C的分别为86%、67%、97%、100%、82%(P=0.018),62例Ⅲ+Ⅳ期患者中S、R、S+R、C+S、C+R、S+R+C的分别为38%、14%、92%、40%、14%、67%(P=0.000)。多因素分析显示S+R、S+R+C是影响预后的因素(P=0.000、0.005)。结论 Ⅰ~Ⅱ期行手术或手术为主综合治疗疗效较好,Ⅲ~Ⅳ期行以手术为主综合治疗预后较好,其中S+R、S+R+C是较好的治疗模式,对中晚期病例行R、C+R预后差。     

蝶窦原发恶性肿瘤16例治疗分析

目的 分析原发蝶窦恶性肿瘤治疗结果。方法 回顾分析2000—2013年我院收治的原发蝶窦恶性肿瘤16例。初诊无颈部淋巴结发生转移。Ⅳ_A期1例, Ⅳ_B期15例。治疗方法包括手术+放疗11例、单纯手术1例、单纯放疗3例、单纯化疗1例。手术全部为减瘤手术。放疗中位剂量69.96 Gy (56.00~ 80.56 Gy)。结果 全组3年LC、DMFS、DFS、DSS分别为67%、69%、44%、58%, 减瘤术+放疗组分别为67%、55%、30%、41%。全部保留眶内容物及颅底。全组LR率25%, 远处转移率37%, 淋巴结复发率6%。预后分析未见与LC率及DSS相关因素。结论 蝶窦肿瘤经减瘤手术+术后放疗在保留眼眶及颅底前提下能取得良好疗效。蝶窦肿瘤治疗后淋巴结复发率低, 临床不建议常规颈部淋巴结预防照射。     

Proton therapy in pediatric skull base and cervical canal low-grade bone malignancies

PURPOSE: To evaluate outcomes and tolerance of high-dose photon and proton therapy in the management of skull base and cervical canal primary bony malignancies in children. PATIENTS AND METHODS: Thirty children were treated postoperatively with high-dose photon-proton (29 patients) or protons-only (1 patient) radiotherapy. Twenty-six patients had chordomas (CH), 3 had low-grade chondrosarcomas (CS), and 1 had an aggressive chondroma (AC). The mean age was 12.8 years. At the time of radiation, all but 1 patient had a gross residue. The anatomic sites affected were skull base (n = 16), cervical canal (n = 1), or both (n = 13). Mean total dose was 68.4 cobalt Gray equivalents, conventionally fractionated. RESULTS: With a mean follow-up of 26.5 months, 5 of 30 children failed locally: 5 of 5 lesions were CH, 5 of 5 patients had experienced pain at presentation (p = 0.03), and 4 of 5 had cervical extension (p = 0.07). The 5-year overall survival/progression-free survival rates for CS and CH were 100%/100% and 81%/77%, respectively. Side effects were scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. Acute toxicity ranged between 0 and 2. Late toxicity of radiotherapy was severe in 1 patient (Grade 3 auditory) and minor or mild in the rest of the population (7 patients with Grade 2 pituitary dysfunction). CONCLUSIONS: High-dose combined fractionated photon-proton therapy is well tolerated in children and allows excellent local control with minimal long-term toxicity.     

Extracranial chordoma: Outcome in patients treated with function-preserving surgery followed by spot-scanning proton beam irradiation

PURPOSE: To evaluate the use of postoperative proton therapy (PT) in extracranial chordoma. PATIENTS AND METHODS: Twenty-six patients were treated. Gross total resection was achieved in 18 patients. Nine patients had cervical, 2 had thoracic, 8 had lumbar, and 7 had sacro-coccygeal chordomas. Thirteen patients had implants. PT was administered after function-preserving surgery, using a gantry and spot scanning, without or with intensity modulation (IMPT; 6 patients), and/or photon-based radiotherapy (RT, 6 patients). Median total dose was 72 cobalt Gray equivalent (CGE; range, 59.4-74.4), with means of 70.5 and 73.2 CGE for patients with and without implants. Median follow-up time was 35 months (range, 13-73 months). Adverse events were scored using the Common Terminology Criteria for Adverse Events grading system (version 3.0). RESULTS: At 3 years, actuarial overall survival (OS) and progression-free survival (PFS) rates were 84% and 77%, respectively. One patient each died of local failure (LF), distant failure (DF), suicide, and secondary tumor. We observed 5 LFs and 3 DFs; 3-year LF-free and DF-free survival rates were 86%. We observed four radiation-induced late adverse events (Grade 2 sensory neuropathy; Grade 3 subcutaneous necrosis, and osteonecrosis; and Grade 5 secondary cancer). In univariate analysis, implants were associated with LF (p = 0.034). Gross residual tumor above 30 mL was negatively associated with OS (p = 0.013) and PFS (p = 0.025). CONCLUSIONS: Postoperative PT for extracranial chordomas delivered with spot scanning offers high local control rates. Toxicity was acceptable. Implants were significantly associated with LF. Residual tumor above 30 mL impacted negatively on OS and PFS.     

局部晚期鼻咽癌同时放化疗的疗效观察

目的提高局部晚期鼻咽癌的局部控制率及总生存率.方法 80例局部晚期鼻咽癌患者前瞻性随机分为放疗合并化疗组(放化组、R+C)和单纯放疗组(单放组、R),放疗方法相同,放化组放疗同时给予顺铂(DDP)和氟尿嘧啶(5-Fu).结果随访3年,放化组较单放组残存率及局部复发率明显下降,差异有显著性(P<0.05),远处转移率差异无显著性(P>0.05).放化组和单放组1,3年生存率分别为95.5%、74.8%和90.0%、59.5%,差异无显著性(P>0.05).总生存率差异无显著性(P＞0.05)放化组毒性较单放组大,后遗症差异无显著性(P>0.05).结论放疗合并使用DDP和5-Fu可减少残存率,提高局部控制率.