Journal of Korean Neurosurgical Society
- 제29권7호
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- Pages.910-917
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- 2000
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- 2005-3711(pISSN)
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- 1598-7876(eISSN)
두개강내 척삭종 및 연골육종 : 수술 및 방사선 치료의 효능
Intracranial Chordomas and Chondrosarcomas : The Effectiveness of Surgery and Radiation Therapy
-
정영섭
(서울대학교 의과대학 신경외과학교실) ;
- 곽호신 (서울대학교 의과대학 신경외과학교실) ;
- 정희원 (서울대학교 의과대학 신경외과학교실) ;
- 박홍준 (서울대학교 의과대학 신경외과학교실) ;
-
백선하
(서울대학교 의과대학 신경외과학교실) ;
- 김동규 (서울대학교 의과대학 신경외과학교실) ;
- 김현집 (서울대학교 의과대학 신경외과학교실)
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Chung, Young-Seob
(Department of Neurosurgery, Seoul National University College of Medicine) ;
- Gwak, Ho-Shin (Department of Neurosurgery, Seoul National University College of Medicine) ;
- Jung, Hee-Won (Department of Neurosurgery, Seoul National University College of Medicine) ;
- Park, Hong-Jun (Department of Neurosurgery, Seoul National University College of Medicine) ;
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Paek, Sun Ha
(Department of Neurosurgery, Seoul National University College of Medicine) ;
- Kim, Dong Gyu (Department of Neurosurgery, Seoul National University College of Medicine) ;
- Kim, Hyun Jib (Department of Neurosurgery, Seoul National University College of Medicine)
- 투고 : 1999.11.15
- 심사 : 2000.01.28
- 발행 : 2000.07.28
초록
Introduction : The management of chordomas and chondrosarcomas in the skull base is difficult due to the critical location, locally aggressive nature, and high recurrence rate. The authors present the effectiveness of surgical removal and radiation therapy on survival and tumor recurrence. Material and Methods : Thirty cranial base chordomas and chondrosarcomas from 23 patients(14 patients with chordomas and 9 patients with chondrosarcomas) were operated in our institution between 1985 and 1998. There were 15 men and 8 women, with a mean age of 40.7 years. The largest diameter of tumors ranged from 15 to 70mm (mean 41.5). The extent of surgical removal was subtotal or total in a half(15 operations). In nineteen operations, tumors were removed by conventional approaches and skull base approaches were applied in 11 operations. Postoperative radiation therapy was performed in 16(70%) patients. The mean duration of follow up is 50 months(1- 156 months). Results : The 3- and 5-year survival rates(YSR) of overall patient are 75% and 67%, respectively. The analysis showed that 1) skull base approach to chordomas and chondrosarcomas showed a tendency to remove more portion of the tumors(p=0.058) but leave more frequent incidence of new deficits(p=0.047) : 2) larger tumor diameter af-fected the extent of removal(p=0.028) : 3) the extent of removal seemed to be the determining factor for overall survival and recurrence-free survival(the 5-YSR and RFSR of subtotal or total removal group are 92% and 80% vs. 40% of partial removal or biopsy group) : 4) conventional radiation therapy improved patient survival(5-YSR of patients who received RT is 76% whereas 5-YSR of those who didn't receive RT is 43%) but failed to prolong long-term recurrence-free survival. Conclusion : The extent of removal and postoperative radiation therapy are determining factors of patients' survival in skull base chordomas and chondrosarcomas. However, none of these factors significantly influenced the survival in multivariate analysis. Aggressive surgical removal of more than subtotal resection combined with postoperative radiation therapy seems to be the choice of therapy in the management of these tumors.