Long-term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas.
J Surg Oncol. 2014 Apr 19;
Authors: Delaney TF, Liebsch NJ, Pedlow FX, Adams J, Weyman EA, Yeap BY, Depauw N, Nielsen GP, Harmon DC, Yoon SS, Chen YL, Schwab JH, Hornicek FJ
BACKGROUND: Negative surgical margins are uncommon for spine sarcomas; hence, adjuvant radiotherapy (RT) may be recommended but tumor dose may be constrained by spinal cord, nerve, and viscera tolerance.
METHODS: Prospective Phase II clinical trial incorporating high dose RT. Eligible patients had primary or locally recurrent thoracic, lumbar, and/or sacral spine/paraspinal chordomas or sarcomas. Treatment included pre- and/or post-operative photon/proton RT?±?radical resection.
RESULTS: Fifty patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n?=?25) or subtotal (n?=?12) resection or biopsy (n?=?13). RT dose was ?72.0?GyRBE in 25 patients and 76.6-77.4?GyRBE in 25 patients. With 7.3-year median follow-up, the 5 and 8-year actuarial local control (LC) rates were 94% and 85% for primary tumors and 81% and 74% for the entire group. Local recurrence was less common for primary tumors, 4/36 (11%) versus 7/14 (50%) for recurrent tumors, P?=?0.002. The 8-year actuarial risk of grade 3-4 late RT morbidity was 13%. No myelopathies were seen. No late neurologic toxicities noted with radiation doses ?72.0?GyRBE while three sacral neuropathies appeared after doses of 76.6-77.4?GyRBE.
CONCLUSIONS: LC with this treatment is high in patients with primary tumors. Late morbidity appears to be acceptable. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
PMID: 24752878 [PubMed – as supplied by publisher]