Premium
Long‐term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas
Author(s) -
DeLaney Thomas F.,
Liebsch Norbert J.,
Pedlow Frank X.,
Adams Judith,
Weyman Elizabeth A.,
Yeap Beow Y.,
Depauw Nicolas,
Nielsen G. Petur,
Harmon David C.,
Yoon Sam S.,
Chen YenLin,
Schwab Joseph H.,
Hornicek Francis J.
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23617
Subject(s) - medicine , chordoma , chondrosarcoma , radiation therapy , surgery , sacrum , radiology
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; 110:115–122 . © 2014 Wiley Periodicals, Inc.