1. Clinical Outcome of Sacral Chordoma Patients Treated with Pencil Beam Scanning Proton Therapy
- Author
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D. Leiser, Sisi Tran, Barbara Bachtiary, M. Walser, Damien C. Weber, Jürgen Beer, Shohei Kawashiro, Alessia Pica, and B. Bojaxhiu
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,610 Medicine & health ,Biopsy ,Chordoma ,Proton Therapy ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Pencil-beam scanning ,Proton therapy ,Retrospective Studies ,Univariate analysis ,Spinal Neoplasms ,medicine.diagnostic_test ,business.industry ,Common Terminology Criteria for Adverse Events ,Tumor Burden ,Radiation therapy ,Oncology ,Cohort ,Radiology ,Neoplasm Recurrence, Local ,business ,Sacral Chordoma - Abstract
AIMS Sacral chordomas are locally aggressive, radio-resistant tumours. Proton therapy has the potential to deliver high radiation doses, which may improve the therapeutic ratio when compared with conventional radiotherapy. We assessed tumour control and radiation-induced toxicity in a cohort of sacral chordoma patients treated with definitive or postoperative pencil beam scanning proton therapy. METHODS AND MATERIALS Sixty patients with histologically proven sacral chordoma treated between November 1997 and October 2018 at the Paul Scherrer Institute with postoperative (n = 50) or definitive proton therapy (n = 10) were retrospectively analysed. Only 10 (17%) patients received combined photon radiotherapy and proton therapy. Survival rates were calculated using the Kaplan-Meier actuarial method. The Log-rank test was used to compare different functions for local control, freedom from distant recurrence and overall survival. Acute and late toxicity were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS The median follow-up was 48 months (range 4-186). Local recurrence occurred in 20 (33%) patients. The 4-year local control, freedom from distant recurrence and overall survival rates were 77%, 89% and 85%, respectively. On univariate analysis, subtotal resection/biopsy (P = 0.02), tumour extension restricted to bone (P = 0.01) and gross tumour volume >130 ml (P = 0.04) were significant predictors for local recurrence. On multivariate analysis, tumour extension restricted to bone (P = 0.004) and gross total resection (P = 0.02) remained independent favourable prognostic factors for local recurrence. Twenty-four (40%), 28 (47%) and eight (11%) patients experienced acute grade 1, 2 and 3 toxicities, respectively. The 4-year late toxicity-free survival was 91%. Two patients developed secondary malignancies to the bladder 3-7 years after proton therapy. CONCLUSIONS Our data indicate that pencil beam scanning proton therapy for sacral chordomas is both safe and effective. Gross total resection, tumour volume
- Published
- 2021
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