Image-guided, intensity-modulated radiation therapy (IG-IMRT) for skull base chordoma and chondrosarcoma: preliminary outcomes

Sahgal, Arjun; Chan, Michael W.Y.; Atenafu, Eshetu G.; Masson-Côté, Laurence; Bahl, Gaurav; Yu, Eugene; Millar, B; Chung, Caroline; Catton, Charles; O’Sullivan, Brian; Irish, Jonathan C.; Gilbert, Ralph W.; Zadeh, Gelareh; Cusimano, Michael D.; Gentili, Fred; Laperrière, Normand

doi:10.1093/neuonc/nou347

Cited by 110 publications

(68 citation statements)

References 20 publications

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“…This has been supported in more recent literature series regarding both chordomas and chondrosarcomas, with median doses of 60 to 66.6 Gy resulting in 5‐year LC rates ranging from 23% to 50% . Technological advances in the field, such as high‐dose, image‐guided intensity‐modulated radiotherapy, have allowed increased doses for chordoma to 76 Gy and for chondrosarcoma to 70 Gy, and this has further pushed these benefits for 5‐year LC rates of 65% and 88%, respectively . Though promising, the use of high‐dose photons is limited by less ability to spare nearby critical organs, which is most notable during treatment of the base of the skull, where the brainstem, optic chiasm, and spinal cord are frequently involved.…”

Section: Introductionmentioning

confidence: 85%

The role of dose escalation and proton therapy in perioperative or definitive treatment of chondrosarcoma and chordoma: An analysis of the National Cancer Data Base

Palm

Oliver

Yang

et al. 2019

Cancer

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Background Chordomas and chondrosarcomas are a rare but challenging subset of tumors to treat; however, previous studies have shown benefits from proton therapy, which are thought to be primarily driven by prescription conformality permitting homogeneous tumor dosing and the allowance of higher doses. No retrospective studies to date have directly compared the outcomes of conventional and particle therapy or examined the role of high doses (specifically ≥70 Gy) in definitive radiotherapy (DRT) or perioperative radiotherapy (PRT) for both types of malignancies. Methods A total of 863 patients with chondrosarcoma and 715 patients with chordoma treated with nonpalliative proton or conventional radiation therapy with a dose range of 20 to 80 Gy and at least 15 months of follow‐up were identified from the National Cancer Data Base for the years 2003‐2014. The primary endpoint of overall survival (OS) was evaluated, and clinical features, including age, sex, grade, clinical stage, and Charlson‐Deyo comorbidity index, were compared. Results Patients receiving DRT were older and had more advanced disease. In DRT for chondrosarcoma, a high dose (40.6% vs 16.9%; P = .006) and proton therapy (75.0% vs 19.1%; P = .046) were associated with improved OS at 5 years in a multivariate analysis. In DRT for chordoma, proton therapy was associated with improved OS at 5 years in a multivariate analysis (100% vs 34.1%; P = .031), and a high dose for chordoma was significant for improved OS in a univariate analysis with both DRT (79.0% vs 54.1%; P = .027) and PRT (83.3% vs 77.4%; P = .007). Conclusions In the largest retrospective series to date, dose escalation and proton radiotherapy were associated with improved OS in patients with chondrosarcoma and chordoma despite limited follow‐up and access to particle therapy.

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Section: Introductionmentioning

confidence: 85%

The role of dose escalation and proton therapy in perioperative or definitive treatment of chondrosarcoma and chordoma: An analysis of the National Cancer Data Base

Palm

Oliver

Yang

et al. 2019

Cancer

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“…Results are summarized in Table 3. [58][59][60][61][62][63][64][65][66][67][68] For these diseases, particle therapy has been historically employed, results in terms of local control and progression free survival with photons RT are acceptable for chondrosarcoma but were on average rather disappointing for chordomas with only one series reporting 5-year local control in excess of 80% and other series reporting local control or progression free survival from 15% to 66%. It is difficult to draw any conclusions from these scarce and heterogeneous data; nevertheless, outcome appears not to be equivalent to that of particles and these findings may suggest that even modern advanced photons cannot achieve adequate target coverage in the skull base for prescription doses in excess of 70 Gy.…”

Section: Clinical Results With Photon External Beam Radiotherapy (Ebrt)mentioning

confidence: 99%

Review of photon and proton radiotherapy for skull base tumours

Fossati

Vavassori²,

Deantonio

et al. 2016

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tAn extremely large variety of benign and malignant tumours occur at skull base; these tumour lesions are in the proximity to structures deputed to relevant physiologic functions, limiting extensive surgical approaches to this body district. Most recent progresses of surgery and radiotherapy have allowed to improve local control with acceptable rates of side effects. Various photon radiotherapy techniques are employed, including 3-dimensional conformal radiotherapy, intensity modulated radiotherapy (IMRT), stereotactic radiotherapy (SRT) and brachytherapy that is manly limited to the treatment of primary or recurrent nasopharyngeal carcinoma. Proton beam radiotherapy is also extensively used thanks to its physical characteristics. Our review, focusing in particular on meningioma, chordoma, and chondrosarcoma, suggests that proton therapy plays a major role in the treatment of malignant tumours whereas photon therapy still plays a relevant role in the treatment of benign tumour lesions.

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“…V ČR je cena pros dávkou 70-76 Gy. Pětiletá lokální kontrola byla 65 % u chordomů a 88 % u chondrosarkomů [26]. Srovnatelná byla i toxicita PBT a fotonové terapie.…”

Section: Cena Protonové Terapieunclassified

Controversy over the Use of Proton Therapy for the Treatment of Tumors of Central Nervous Systém

Petera¹

2018

Klin Onkol

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Východiska: Protonová terapie (proton beam ther apy -PBT) je v současnosti jedním z nejvíce diskutovaných onkologických témat. PBT se vyznačuje ně kte rými fyzikálními charakteristikami, které ji teoreticky zvýhodňují oproti standardní fotonové léčbě. Na druhé straně ji provázejí nejistoty v lokalizaci dávkového maxima (Braggův peak) v reálných klinických situacích a v radiobio logické účinnosti v oblasti distálního konce protonového paprsku. Dosavadní klinické výsledky PBT bohužel zatím neodpovídají vkládaným nadějím. Cíl: V článku jsou prezentovány výsledky protonové léčby v porovnání s výsledky standardní fotonové terapie u low-a high-grade gliomů, pituitárních adenomů, vestibulárních schwannomů, chordomů a chondrosarkomů a pediatrických nádorů centrálního nervového systému. V žádné z těchto indikací neprokázala PBT vyšší kontrolu nádoru ani menší toxicitu než moderní fotonová léčba. Alarmující je vyšší riziko postradiačních nekróz mozkové tkáně. Nejvíce se PBT zvažuje u pediatrických tumorů, protože radiobio logické modely predikují nižší poškození neurokognitivních funkcí a redukci rizika sekundárních malignit. Tato hypotéza však má své odpůrce a dostatečná klinická data nejsou dostupná. Cena PBT je několikanásobně vyšší v porovnání s léčbou fotonovou. Závěr: PBT představuje převratnou technologii v moderní léčbě zářením, doposud však klinická data nepotvrdila její superioritu oproti moderním technikám fotonové léčby. Indikace PBT by měly být individuálně zvažovány u pa cientů, kde standardní techniky moderní fotonové terapie neumožňují dodržení dávkových limitů na zdravé tkáně. Klíčová slovaprotonová léčba -nádory -centrální nervový systém SummaryBackground: Proton beam ther apy (PBT) is one of the most discussed topics in contemporary oncology. PBT is characterized by certain physical properties that make it theoretically better as a treatment than standard photon ther apy. On the other hand, there are some uncertainties regard ing the localization of the dose peak (Bragg peak) in real clinical situations and the value of radiobio logical effectiveness at the end of proton beam. Unfortunately, the high expectations of PBT have not been fulfilled in published clinical studies. Aim: In the present article, the results of PBT are compared with those of standard photon ther apy for the treatment of low-and high--grade gliomas, pituitary adenomas, vestibular schwannomas, chordomas and chondrosarcomas, and pediatric central nervous system tumors. PBT was not better in tumor control or in reduc ing toxicity than photon ther apy. The higher risk of post-radiation brain tissue necrosis after PBT is alarming. PBT is mostly considered for pediatric tumors, because the radiobio logical models predict lower damage to neurocognitive functions and a reduction in secondary malignancies. However, this hypothesis has its opponents and sufficient clinical data to justify the models are still lacking. The cost of PBT is several times higher than that of photon ther apy. Results: PBT is a revolutionary technology in modern ra...

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Image-guided, intensity-modulated radiation therapy (IG-IMRT) for skull base chordoma and chondrosarcoma: preliminary outcomes

Abstract: We report favorable survival, local control and adverse event rates following high dose IG-IMRT. Further follow-up is needed to confirm long-term efficacy.

Cited by 110 publications

References 20 publications

The role of dose escalation and proton therapy in perioperative or definitive treatment of chondrosarcoma and chordoma: An analysis of the National Cancer Data Base

The role of dose escalation and proton therapy in perioperative or definitive treatment of chondrosarcoma and chordoma: An analysis of the National Cancer Data Base

Review of photon and proton radiotherapy for skull base tumours

Controversy over the Use of Proton Therapy for the Treatment of Tumors of Central Nervous Systém

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