Role of intraoperative radiotherapy in the treatment of sacral chordoma

Jullien-Petrelli, Ariel Christian; García-Sabrido, J.L.; Orue-Echebarria, Maitane I.; Rojas, Pilar; Alvarez, A.; Serrano, Javier García; Fa, Calvo; Calvo-Haro, José Antonio; Lasso, José M.; Asencio, José Manuel

doi:10.1016/j.spinee.2017.08.255

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…The possibility to repair large superficial defects after aggressive tumor surgery and to obliterate the dead space resulting from total or partial sacrectomy allowed larger resections with a better chance to achieve clear oncological margins, 23,24 even in sacral chordoma, 25 which represent the second cause of sacrectomies in this study.…”

Section: Discussionmentioning

confidence: 78%

The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction

Lasso¹,

Pinilla²,

Vásquez

et al. 2020

Ann Plast Surg

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Introduction: Sacropelvic resection is the treatment of choice for pelvic bone tumors and can be associated with intraoperative electron radiotherapy (IOERT) to optimize local control of the disease. Reconstruction with flaps also is essential to avoid pelvic complications. There is scarcity of publications evaluating outcomes of reconstructive procedures associated with IOERT. Methods: A prospective study in 53 patients between 2005 and 2018 was performed. Thirty-four patients received IOERT (group I [GI]) and 19 did not (GII). We examined demographic characteristics, tumor pathology, type of resection and volume of surgical specimen, timing of surgery, IOERT doses, postoperative stay, and complications. We used it for reconstruction rectus abdominis, gluteal, omental and gracilis, superior gluteal artery perforator flap, and free flaps. Results: Colonic adenocarcinoma and chordoma were the most frequent tumors. The median (interquartile range) IOERT dose was 1250 (1000-1250) cGy; operating time was 10.15 (8.6-14.0) hours versus 6.0 (5.0-13.0) hours, hospital stay was 37 (21.2-63.0) days versus 26.0 (12.0-60.0) days, and volume of surgical specimen was 480.5 (88.7-1488.0) mL versus 400 (220.0-6700.0) mL in GI and GII, respectively. Operating time was significantly longer in GI (P < 0.03). There were significant positive correlations between operating time, hospital stay, and volume of surgical specimen. Main complications were exudative wounds (50% vs 31.5%), wound dehiscence (41.1% vs 31.5%), and seroma (29.4% vs 26.3%) in GI and GII, respectively. Complications were similar to previous studies with or without radiotherapy. Conclusions: Under a reconstructive approach, IOERT did not harm flap survival nor increased pelvic complications when compared with similar cases without IOERT.

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Section: Discussionmentioning

confidence: 78%

The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction

Lasso¹,

Pinilla²,

Vásquez

et al. 2020

Ann Plast Surg

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“…A recent study provided evidence in support of this conjecture ( 31 ). Published data have demonstrated that administration of radiotherapy has benefits in chordoma patients ( 32 – 34 ). Similarly, we found that radiotherapy significantly improved PDC prognosis and could also independently predict both patients’ PFS and OS.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological and Prognostic Characteristics in Dedifferentiated/Poorly Differentiated Chordomas: A Pooled Analysis of Individual Patient Data From 58 Studies and Comparison With Conventional Chordomas

et al. 2021

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BackgroundCurrently, the clinicopathological and prognostic characteristics of dedifferentiated chordoma (DC) and poorly differentiated chordoma (PDC) remain poorly understood. In this study, we sought to characterize clinicopathological parameters in a large PDC/DC cohort and determine their correlations with progression-free survival (PFS) and overall survival (OS) of patients. We also attempted to compare clinical features between PDC/DC and conventional chordoma (CC).MethodsLiterature searches (from inception to June 01, 2020) using Medline, Embase, Google Scholar and Wanfang databases were conducted to identify eligible studies according to predefined criteria. The local database at our center was also retrospectively reviewed to include CC patients for comparative analysis.ResultsFifty-eight studies from the literature and 90 CC patients from our local institute were identified; in total, 54 PDC patients and 96 DC patients were analyzed. Overall, PDC or DC had distinct characteristics from CC, while PDC and DC shared similar clinical features. Adjuvant radiotherapy and chemotherapy were associated with both PFS and OS in PDC patients in the univariate and/or multivariate analyses. In the DC cohort, tumor resection type, adjuvant chemotherapy and tumor dedifferentiation components significantly affected PFS, whereas none of them were predictive of outcome in the multivariate analysis. By analyzing OS, we found that surgery, resection type and the time to dedifferentiation predicted the survival of DC patients; however, only surgery remained significant after adjusting for other covariables.ConclusionsThese data may offer useful information to better understand the clinical characteristics of PDC/DC and may be helpful in improving the outcome prediction of patients.

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“…For instance, studies investigating the local recurrence rate and long-term survival rate of breast cancer patients who received IORT and EBRT found that IORT rates were noninferior to EBRT rates [5][6][7][8]. In cases where EBRT is di cult to implement, such as sacral chordoma, locally advanced rectal cancer, pancreatic cancer, cervical cancer, and head and neck cancer with a high local recurrence rate, IORT may be a useful option [9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Development of Inclined Applicators for Flattened Beam Intraoperative Radiotherapy

Kim

Ahn

Park

et al. 2023

Preprint

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Purpose: We introduce a 3D-printed applicator for Intraoperative Radiation Therapy (IORT) using the INTRABEAM system. The applicator is designed to spare normal tissue, increase indications, and evaluate its clinical use in various intraoperative cases. Methods: We designed and fabricated inclined applicators at 0° and 45° to generate flattened and unflattened beams and shield leakage dose to non-target regions. We evaluated the characteristics of the applicator, including dose uniformity, percentage depth dose, leakage, and dose rate of the beam. Results: The uniformity of developed applicators at depths of 0, 2, 5, and 15 mm were as follows: 1.23, 1.28, 1.30, and 1.22 for a flattened beam, and 1.29, 1.32, 1.27, and 1.25 for an unflattened beam, respectively. No leakage dose was measured at a distance of 1 mm from the surface, and the measured dose rates after 3 min of irradiation for the flattened and unflattened beams of the 0° and 45° applicators were 51.0 and 52.9 cGy and 48.5 and 54.8 cGy, respectively. Conclusions: The developed applicator demonstrated a uniform beam and leakage shielding to minimize radiation exposure to normal tissue. Customized applicators facilitated IORT treatment of chest and abdominal lesions near or on critical organs. The proposed method has been dose calibrated, and we proceeded with clinical application.

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Role of intraoperative radiotherapy in the treatment of sacral chordoma

Cited by 8 publications

References 35 publications

The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction

The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction

Clinicopathological and Prognostic Characteristics in Dedifferentiated/Poorly Differentiated Chordomas: A Pooled Analysis of Individual Patient Data From 58 Studies and Comparison With Conventional Chordomas

Development of Inclined Applicators for Flattened Beam Intraoperative Radiotherapy

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