Abstract
Simple SummarySkull-base chondrosarcoma is a rare locally aggressive or malignant group of cartilaginous neoplasm. The standard of care consists of surgery and high-dose radiation therapy, better if with particle, due to their radioresistance and proximity to organs at risk such as brainstem and optic pathways. Due to the rarity of the tumor and its site, outcomes in terms of local control and toxicity of patients with this malignancy after receiving particle therapy has been documented only in a limited number of series with a restricted number of patients, in particular with regard to carbon ions. The aim of our retrospective study is to assess the role of particle therapy (protons and carbon ions) after surgery in our Institute in skull-base chondrosarcomas. Background: The standard treatment for skull base chondrosarcoma (SB-CHS) consists of surgery and high-dose radiation therapy. Our aim was to evaluate outcome in terms of local control (LC) and toxicity of proton therapy (PT) and carbon ion (CIRT) after surgery. Materials and methods: From September 2011 to July 2020, 48 patients underwent particle therapy (67% PT, 33% CIRT) for SB-CHS. PT and CIRT total dose was 70 GyRBE (relative biological effectiveness) in 35 fractions and 70.4 GyRBE in 16 fractions, respectively. Toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE v5). Results: After a median follow-up time of 38 months, one local failure (2%) was documented and the patient died for progressive disease. Overall, 3-year LC was 98%. One (2%) and 4 (8%) patients experienced G3 acute and late toxicity, respectively. White-matter brain changes were documented in 22 (46%) patients, but only 7 needed steroids (G2). No patients had G3 brain toxicity. No G4–5 complications were reported. We did not find any correlation between high-grade toxicity or white-matter changes and characteristics of patients, disease and surgery. Conclusions: PT and CIRT appeared to be effective and safe treatments for patients with SB-CHS, resulting in high LC rates and an acceptable toxicity profile.
Highlights
Skull base chondrosarcoma (SB-CHS) is a rare malignant bone tumor arising from the chondrocytes or their precursor cells involved in the endochondral ossification, commonly at the petroclival junction, representing 6% of all skull base tumors and approximately0.15% of all intracranial neoplasms [1,2]. 4.0/).CHS are subclassified into the conventional, dedifferentiated, clear cell and mesenchymal subtypes
We reviewed the Institutional patient registry, collecting data of patients with histological diagnosis of skull base chondrosarcoma (SB-CHS) treated with particle therapy at Center for Oncological Hadrontherapy (CNAO) between September 2011 and July 2020
Forty-eight patients with histological diagnosis of SB-CHS treated with proton therapy (PT) or CIRT at CNAO between September 2011 and July 2020 were included in the current analyses
Summary
Skull base chondrosarcoma (SB-CHS) is a rare malignant bone tumor arising from the chondrocytes or their precursor cells involved in the endochondral ossification, commonly at the petroclival junction, representing 6% of all skull base tumors and approximately0.15% of all intracranial neoplasms [1,2]. 4.0/).CHS are subclassified into the conventional (most frequent), dedifferentiated, clear cell and mesenchymal subtypes. Grading is important in CHS for prognosis and it is primarily based on nuclear size and staining, cellularity and number of mitoses. Grade I CHS are moderately cellular and contain hyperchromatic, plump nuclei of uniform size, without mitoses. Grade II CHSs are more cellular and cointain a greater degree of nuclear atypia, hyperchromasia and nuclear size; some mitoses can be found. In Grade III CHSs, mitoses are detected and lesions are more cellular and pleomorphic [5]. The standard treatment for skull base chondrosarcoma (SB-CHS) consists of surgery and high-dose radiation therapy. Our aim was to evaluate outcome in terms of local control (LC) and toxicity of proton therapy (PT) and carbon ion (CIRT) after surgery. Materials and methods: From September 2011 to July 2020, 48 patients underwent particle therapy (67% PT, 33% CIRT) for SB-CHS. Results: After a median follow-up time of months, one local failure (2%) was documented and the patient died for progressive disease
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