[Proposal] Here, we retrospectively evaluate risk factors for radiation necrosis and local recurrence after PBT for skull base chordoma or chondrosarcoma. [Patients and Methods] We analyzed 101 patients who received PBT for skull base chordomas and chondrosarcomas from January 1989 to February 2021. Multivariable logistic regression models were applied for local recurrence, temporal lobe radiation necrosis rates, and temporal lobe radiation necrosis. [Results] In multivariate analysis, chordoma and large tumor size were independent significant factors for local recurrence. The 1-, 2-, 3-, 4- and 5-year local recurrence rates were 3.9%, 16.9%, 20.3%, 28.5% and 44.0% for chordoma and 0%, 0%, 0%, 0% and 7.1% for chondrosarcoma, respectively. The local recurrence rates of small tumors (<30 mm) were 4.3%, 14.7%, 17.7%, 17.7% and 25.9%, and those for large tumors were 3.6%, 15.1%, 19.2%, 32.7% and 59.6%, respectively. In multivariate analysis, BED Gy10and total dose were risk factors for radiation necrosis. [Conclusions] For skull base chordoma and chondrosarcoma, the risk factors of local recurrence were chordoma and large tumor size, and those of radiation necrosis were BED Gy10and total dose, respectively. DVH analysis is needed to investigate the risk factors for brain necrosis in more detail.
[目的] 本研究旨在回顾性分析颅底脊索瘤或软骨肉瘤接受质子束治疗后发生放射性坏死及局部复发的危险因素。[患者与方法] 我们分析了1989年1月至2021年2月期间接受质子束治疗的101例颅底脊索瘤和软骨肉瘤患者。采用多变量逻辑回归模型分析局部复发、颞叶放射性坏死发生率及颞叶放射性坏死的相关因素。[结果] 多变量分析显示，脊索瘤和大肿瘤体积是局部复发的独立显著危险因素。脊索瘤的1年、2年、3年、4年和5年局部复发率分别为3.9%、16.9%、20.3%、28.5%和44.0%，而软骨肉瘤分别为0%、0%、0%、0%和7.1%。小肿瘤（<30毫米）的局部复发率为4.3%、14.7%、17.7%、17.7%和25.9%，大肿瘤的局部复发率分别为3.6%、15.1%、19.2%、32.7%和59.6%。多变量分析显示，BED Gy10和总剂量是放射性坏死的危险因素。[结论] 对于颅底脊索瘤和软骨肉瘤，局部复发的危险因素是脊索瘤和大肿瘤体积，而放射性坏死的危险因素分别是BED Gy10和总剂量。需要进一步通过剂量体积直方图分析来更详细地研究脑坏死的危险因素。
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