质子碳离子治疗复发性颅底及颈椎脊索瘤和软骨肉瘤的初步临床结果  

The preliminary result of proton and carbon ion therapy for recurrent chordoma and chondrosarcoma of skull base and cervical spine

作　　者：管西寅 高晶 胡集祎 胡微煦 杨婧 胡超苏 孔琳 陆嘉德 Guan Xiyin;Gao Jing;Hu Jiyi;Hu Weixu;Yang Jing;Hu Chaosu;Kong Lin(Department of Radiation Oncology,Shanghai Proton and Heavy Ion Center,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy,Shanghai 201321,China;Department of Radiation Oncology,Shanghai Proton and Heavy Ion Center,Fudan University Cancer Hospital,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy,Shanghai 200032,China)

机构地区：[1]上海市质子重离子医院放射治疗科,上海质子重离子放射治疗工程技术研究中心,201321 [2]上海市质子重离子医院放射治疗科,复旦大学附属肿瘤医院放射治疗科,上海质子重离子放射治疗工程技术研究中心,200032

出　　处：《中华放射医学与防护杂志》2020年第6期434-438,共5页Chinese Journal of Radiological Medicine and Protection

基　　金：上海市市级医院新兴前沿技术联合攻关项目(SHDC12016120);上海市科技创新行动计划(19411951000)。

摘　　要：目的探讨采用质子碳离子笔形束扫描技术治疗复发性颅底及颈椎脊索瘤和软骨肉瘤患者的不良反应和近期疗效。方法收集2014年6月30日至2018年7月30日收治的45例复发性颅底及颈椎肿瘤患者,其中脊索瘤39例,软骨肉瘤6例,中位肿瘤体积57 cm3(6.6~231.7 cm3)。术后复发患者31例,术后放疗后复发14例。行单纯质子治疗1例,质子加碳离子放疗21例,单纯碳离子治疗23例。结果所有患者均顺利完成治疗。患者中位随访时间29个月(8~57个月),2年总生存率、局部控制率及无进展生存率分别为82.7%、85.3%及73.8%。除1例3级急性口腔黏膜炎外,未见其他3~4级急性或晚期不良反应。粒子射线放疗作为再程放疗的患者与第1次放疗的患者,其总生存率分别为50.3%和96.2%(χ^2=16.969,P<0.05)。结论质子重离子治疗复发性颅底及颈椎脊索瘤软骨肉瘤取得了较好的短期疗效,长期疗效及不良反应仍需要进一步随访。Objective To evaluate the short-term tumor control and toxicity of recurrent skull base and cervical spine chordoma and chondrosarcoma in patients treated with pencil beam scanning proton and heavy ion therapy.Methods Between June 30th,2014 and July 30th,2018,a total of 45 skull base and cervical spine chordoma(n=39)and chondrosarcoma(n=6)patients(28 males and 17 females;mean age at initial presentation of 44 years,range,14-76 years)were treated in our center for the course of radiotherapy.The median maximum tumor volume was 57 cm3(range,6.6-231.7 cm3).There were 31 post-operative recurrent patients and 14 post-operative and post-radiated recurrent patients.One patient received proton therapy,21 patients received combined proton and carbon ion therapy,23 patients received carbon ion therapy.Results All patients completed the whole course of the treatment.The median follow-up time was 29 months(range:8-57 months),the 2-year overall survival(OS),local control(LC),and progression-free survival(PFS)were 82.7%,85.3%,and 73.8%,respectively.There were no other grade 3-4 acute or late radiation-induced toxicity except one grade 3 acute mucositis.The 2-year OS rates for patients after first-time radiation vs.re-irradiation were 96.2%and 50.3%(χ^2=16.969,P<0.05).Conclusions The short-term outcomes of pencil beam scanning proton and heavy ion therapy for recurrent skull base and cervical spine chordoma and chondrosarcoma is favorable.Further study is needed for long-term efficacy and safety.

关 键 词：脊索瘤 软骨肉瘤 质子 碳离子 放射治疗 

分 类 号：R739.42[医药卫生—肿瘤] R738.3[医药卫生—临床医学]