Carbon ion radiotherapy for sacral chordoma: A retrospective nationwide multicentre study in Japan

Demizu, Yusuke; Imai, Reiko; Kiyohara, Hiroki; Matsunobu, Akira; Okamoto, Masahiko; Okimoto, Tomoaki; Tsuji, Hiroshi; Ohno, Tatsuya; Shioyama, Yoshiyuki; Nemoto, Kenji; Nakano, Takashi; Kamada, Tadashi

doi:10.1016/j.radonc.2020.09.018

Cited by 40 publications

(46 citation statements)

References 26 publications

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“…1, The most common exclusion reasons were pooling of spine/sacrum lesions with other lesion locations (n = 14), the use of photon-only radiotherapy (n = 9), and failure to report one of the outcomes of interest (n = 3). Of the included articles, 8 examined proton-only therapy (Table 1), 11,22,33,[40][41][42][43][44] 11 examined combined proton/photon radiotherapy (Table 2), 1,[12][13][14][15][16][17][18][19][20]45 14 examined CIRT (Table 3), 21,[23][24][25][26][27][28][29][30][31][32][34][35][36] and 3 examined a combination of proton radiotherapy and CIRT or another hadron therapy (Table 4). [37][38][39] All included studies were at high risk of reporting bias.…”

Section: Resultsmentioning

confidence: 99%

“…All were level IV evidence based on the North American Spine Society Levels of Evidence, 46 except the study by Mima et al 37 (level III evidence). Most studies were published by five centers: the Heidelberg Ion Beam Therapy Center (n = 3), 21,31,34 the Hyogo Ion Beam Medical Center in Japan (n = 4), 11,23,37,39 the MGH (n = 9), 1,13-17, 19, 20,22 the National Institute of Radiological Sciences in Chiba, Japan (n = 10), 23-29, 32, 33,36 and the Paul Scherrer Institute (n = 4). [41][42][43][44] Unless otherwise stated, the results are reflective of adjuvant particle radiation before, after, or combined with surgery.…”

Section: Resultsmentioning

confidence: 99%

“…21,[23][24][25][26][27][28][29][30][31][32][34][35][36] Studies were small (7-219 patients), with only 2 studies from the National Institute of Radiological Sciences in Chiba, Japan, including more than 100 patients. 23,27 The median age was 54-67 years, patients were 48%-80% male, and the median follow-up was 18-80 months. Except in the study by Matsumoto et al, 47 in all treated patients (94%-100%) chordoma was the most common disease, with 12 studies including only chordoma patients.…”

Section: Cirt Seriesmentioning

confidence: 99%

“…Acute toxicities occurred in 26%-48% (0%-18% suffered CTC grade ≥ 3 events), and late toxicities occurred in 59%-89% (0%-21% suffered CTC grade ≥ 3 events). Eight studies examined strictly nonsurgical patients, 23,[26][27][28][29][30]32,35 and in 6 of these studies patients were treated at the National Institute of Radiological Sciences, 23,[26][27][28][29]32 so much of the data from these sources were from a similar and likely overlapping set of nonsurgical patients treated at the National Institute of Radiological Sciences. Five-year outcomes were LC 72%-100%, OS 52%-86%, and DFS 50%-53%.…”

Section: Cirt Seriesmentioning

confidence: 99%

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Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum

Pennington

Ehresman

Elsamadicy

et al. 2021

Neurosurgical Focus

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OBJECTIVE Long-term local control in patients with primary chordoma and sarcoma of the spine and sacrum is increasingly reliant upon en bloc resection with negative margins. At many institutions, adjuvant radiation is recommended; definitive radiation is also recommended for the treatment of unresectable tumors. Because of the high off-target radiation toxicities associated with conventional radiotherapy, there has been growing interest in the use of proton and heavy-ion therapies. The aim of this study was to systematically review the literature regarding these therapies. METHODS The PubMed, OVID, Embase, and Web of Science databases were queried for articles describing the use of proton, combined proton/photon, or heavy-ion therapies for adjuvant or definitive radiotherapy in patients with primary sarcoma or chordoma of the mobile spine and sacrum. A qualitative synthesis of the results was performed, focusing on overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), and disease-specific survival (DSS); local control; and postradiation toxicities. RESULTS Of 595 unique articles, 64 underwent full-text screening and 38 were included in the final synthesis. All studies were level III or IV evidence with a high risk of bias; there was also significant overlap in the reported populations, with six centers accounting for roughly three-fourths of all reports. Five-year therapy outcomes were as follows: proton-only therapies, OS 67%–82%, PFS 31%–57%, and DFS 52%–62%; metastases occurred in 17%–18% and acute toxicities in 3%–100% of cases; combined proton/photon therapy, local control 62%–85%, OS 78%–87%, PFS 90%, and DFS 61%–72%; metastases occurred in 12%–14% and acute toxicities in 84%–100% of cases; and carbon ion therapy, local control 53%–100%, OS 52%–86%, PFS (only reported for 3 years) 48%–76%, and DFS 50%–53%; metastases occurred in 2%–39% and acute toxicities in 26%–48%. There were no studies directly comparing outcomes between photon and charged-particle therapies or comparing outcomes between radiation and surgical groups. CONCLUSIONS The current evidence for charged-particle therapies in the management of sarcomas of the spine and sacrum is limited. Preliminary evidence suggests that with these therapies local control and OS at 5 years are comparable among various charged-particle options and may be similar between those treated with definitive charged-particle therapy and historical surgical cohorts. Further research directly comparing charged-particle and photon-based therapies is necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Cirt Seriesmentioning

confidence: 99%

Section: Cirt Seriesmentioning

confidence: 99%

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Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum

Pennington

Ehresman

Elsamadicy

et al. 2021

Neurosurgical Focus

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“…ongoing [39,40]. CIRT of the sacral chordoma also showed promising results, with OS rates ranging from 78% to 84% at 5 years [41][42][43][44].…”

Section: Bone and Soft-tissue Sarcomamentioning

confidence: 93%

Who Will Benefit from Charged-Particle Therapy?

Kim

2021

Cancer Res Treat

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Charged-particle therapy (CPT) such as proton beam therapy (PBT) and carbon-ion radiotherapy (CIRT) exhibit substantial physical and biological advantages compared to conventional photon radiotherapy. As it can reduce the amount of radiation irradiated in the normal organ, CPT has been mainly applied to pediatric cancer and radioresistent tumors in the eloquent area. Although there is a possibility that more patients can benefit from it, high set-up cost and dearth of high level of clinical evidence hinders wide spread of CPT. This review aims to present recent clinical results of PBT and CIRT in selected diseases focusing on possible indications of CPT. We also discussed how clinical studies are conducted to increase the number of patients who can benefit from CPT considering the high cost of it.

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Comparison of Oncologic Outcomes and Treatment-Related Toxicity of Carbon Ion Radiotherapy and En Bloc Resection for Sacral Chordoma

et al. 2022

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IMPORTANCE Maximal resection is the preferred management for sacral chordomas but can be associated with unacceptable morbidity. Outcomes with radiotherapy are poor. Carbon ion radiotherapy (CIRT) is being explored as an alternative when surgery is not preferred. OBJECTIVE To compare oncologic outcomes and treatment-related toxicity of CIRT and en bloc resection for sacral chordoma. DESIGN, SETTING, AND PARTICIPANTSUnivariable logistic regression was performed to evaluate the association between treatment type and oncologic and toxicity outcomes in this retrospective cohort study. Nearest-neighbor propensity score matching was used to match the CIRT cohort with the en bloc resection cohort and 10 National Cancer Database (NCDB) cohorts separately, with the objective of obtaining more homogeneous cohorts when comparing treatments. Patient-and tumorrelated characteristics from 2 institutional cohorts were collected for patients diagnosed with sacral

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Carbon ion radiotherapy for sacral chordoma: A retrospective nationwide multicentre study in Japan

Cited by 40 publications

References 26 publications

Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum

Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum

Who Will Benefit from Charged-Particle Therapy?

Comparison of Oncologic Outcomes and Treatment-Related Toxicity of Carbon Ion Radiotherapy and En Bloc Resection for Sacral Chordoma

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