Abstract
PurposeTo evaluate the short-term outcomes in terms of tumor control and toxicity of patients with skull base or cervical spine chordoma and chondrosarcoma treated with intensity-modulated proton or carbon-ion radiation therapy.MethodsBetween 6/2014 and 7/2018, a total of 91 patients were treated in our Center. The median age was 38 (range, 4–70) years. Forty-six (50.5%) patients were treated definitively for their conditions as initial diagnosis, 45 (49.5%) patients had recurrent tumors including 14 had prior radiotherapy. The median gross tumor volume was 37.0 (range, 1.6–231.7) cc. Eight patients received proton therapy alone, 28 patients received combined proton and carbon ion therapy, 55 patients received carbon-ion therapy alone.ResultsWith a median follow-up time of 28 (range, 8–59) months, the 2-year local control (LC), progression free (PFS) and overall survival (OS) rates was 86.2, 76.8, and 87.2%, respectively. Those rates for patients received definitive proton or carbon-ion therapy were 86.7, 82.8, and 93.8%, respectively. On multivariate analyses, tumor volume of > 60 cc was the only significant factor for predicting PFS (p = 0.045), while re-irradiation (p = 0.012) and tumor volume (> vs < 60 cc) (p = 0.005) were significant prognosticators for OS. Grade 1–2 late toxicities were observed in 11 patients, and one patient developed Grade 3 acute mucositis.ConclusionsLarger tumor volume and re-irradiation were related to inferior survival for this group of patients. Further follow-up is needed for long-term efficacy and safety.
Highlights
Chordomas originate from transformed undifferentiated notochordal remnants that exist throughout the skull base and axial skeleton
Patients and particle radiation therapy (RT) Ninety-one consecutive and non-selected patients with cervical and skull base chordomas or chondrosarcomas treated at Shanghai Proton and Heavy Ion Center (SPHIC) with intensity-modulated proton (IMPT) or intensity-modulated carbon ion radiotherapy (IMCT) between 6/2014 and 7/2018 were included in the current analyses
The remaining 69 patients were treated according to our institutional dose escalation schemes: 22 patients received IMRT to 50 GyE/ 25 fractions to clinical target volume (CTV) 2 plus IMCT boost to the CT-boost to 15~21 GyE/5~8 fractions; 47 patients received 45 GyE/ 15 fractions to the CTV followed to a boost to CTV-boost to the total of 63~69GyE/21~23 fractions
Summary
Chordomas originate from transformed undifferentiated notochordal remnants that exist throughout the skull base and axial skeleton. The incidence of clival chordomas is approximately 0.8–1/106 [1, 2]. Chondrosarcomas arise from cartilage and represent 10–20% of malignant. Both chordomas and chondrosarcomas are locally invasive, and surgery is their mainstay treatment. Complete resection is nearly universally constrained for the skull base lesions by their proximity to critical neural or vascular structures [4]. Adjuvant radiation therapy (RT) can improve local control (LC) and overall survival (OS). High dose RT is usually not feasible due to the dose constrain of the critical organs at risk (OARs) the optic nerve/
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