Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas

DeLaney, Thomas F.; Liebsch, Norbert J.; Pedlow, Francis X.; Adams, J.; Dean, Susan; Yeap, Beow Y.; McManus, P.L.; Rosenberg, Andrew E.; Nielsen, G. Petur; Harmon, David C.; Spiro, Ira J.; Raskin, Kevin A.; Suit, Herman D.; Yoon, Sam S.; Hornicek, Francis J.

doi:10.1016/j.ijrobp.2008.08.058

Cited by 238 publications

(203 citation statements)

References 30 publications

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“…Their data indicated significantly worse LC and OS in patients with recurrent chondrosarcomas and chordomas of the mobile spine. 15 Age was found to be a highly significant prognostic factor in our evaluation. Noel et al were also able to demonstrate a correlation between age and outcome.…”

Section: Discussionmentioning

confidence: 60%

High control rate in patients with chondrosarcoma of the skull base after carbon ion therapy: First report of long‐term results

Uhl

Mattke

Welzel

et al. 2014

Cancer

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BACKGROUND:The current study was performed to evaluate the safety and effectiveness of irradiation with carbon ions using raster scanning as well as prognostic factors in patients with skull base chondrosarcomas. METHODS: Between 1998 and 2008, 79 patients with chondrosarcoma of the skull base were treated using carbon ions in raster scanning. The applied median total dose was 60 gray equivalent (GyE) at 3 GyE per fraction. Local control and overall survival (OS) were evaluated using the Kaplan-Meier method. Longterm toxicity was quantitatively assessed using questionnaires. RESULTS: The median follow-up after irradiation was 91 months (range, 3 months-175 months). Within the follow-up, 10 patients developed local disease recurrence. The 3-year, 5-year, and 10-year local control rates were 95.9%, 88%, and 88%, respectively; the corresponding OS rates were 96.1%, 96.1%, and 78.9%, respectively. With a median follow-up of 110 months after first diagnosis, the corresponding 3-year, 5-year, and 10-year OS rates were 97.5%, 97.5%, and 91.5%, respectively. Age 45 years and boost volume 55 mL were associated with significantly better local control rates. We observed a clinically relevant improvement in cranial nerve deficits 7 to 10 years after treatment (range, 45.5%-53.3%) compared with the baseline (73.4%). During follow-up, none of the patients in the current study developed a secondary malignancy. CONCLUSIONS: Carbon ion therapy is a safe and effective treatment in patients with chondrosarcoma of the skull base. For further evaluation, a prospective randomized phase 3 trial comparing protons versus carbon ions has been recruiting patients with low-grade and intermediate-grade chondrosarcoma of the skull base since 2009. Cancer 2014;120:1579-85.

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Section: Discussionmentioning

confidence: 60%

High control rate in patients with chondrosarcoma of the skull base after carbon ion therapy: First report of long‐term results

Uhl

Mattke

Welzel

et al. 2014

Cancer

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“…Patients with postoperative complications such as recurrence, infection, and hardware failure were not excluded from the study. All patients underwent preoperative radiation of 19.8 Gy or 50.4 Gy (based on perceived risk of wound healing complications and the planned wound closure) followed by resection and postoperative radiation boost radiation to bring the radiation dose to the tumor bed to approximately 70.2 Gy as previously described [3][4][5].…”

Section: Methodsmentioning

confidence: 99%

How Does the Level of Sacral Resection for Primary Malignant Bone Tumors Affect Physical and Mental Health, Pain, Mobility, Incontinence, and Sexual Function?

Phukan

Herzog

Boland

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background En bloc resection for treatment of sacral tumors is the approach of choice for patients with resectable tumors who are well enough to undergo surgery, and studies describe patient survival, postoperative complications, and recurrence rates associated with this treatment. However, most of these studies do not provide patient-reported functional outcomes other than binary metrics for bowel and bladder function postresection. Questions/purposes The purpose of this study was to use validated patient-reported outcomes tools to compare quality of life based on level of sacral resection in terms of (1) physical and mental health; (2) pain; (3) mobility; and (4) incontinence and sexual function. Methods Our analysis included 33 patients (19 men, 14 women) who had a mean age of 53 years (range, 22-72 years) with a quality-of-life survey administered at a mean postoperative followup of 41 months (range, 6-123 months). The majority of patient-reported quality-of-life outcome surveys for this study were taken from the National Institute of Health's Patient Reported Outcome Measurement Information System (PROMIS) system. To assess physical and mental health, the PROMIS Global Items Survey with physical and mental subscores, Anxiety, and Depression scores were used. Pain outcomes were assessed using PROMIS Pain Intensity and Pain Interference surveys. Patient-reported lower extremity function was assessed using the PROMIS Mobility Survey. Patientreported quality of life for sexual function was assessed using the PROMIS Sex Interest and Orgasm survey, One-way analysis of variance tests on means or ranks were used to conduct statistical analysis between levels. Results Patients with more caudal resections had higher physical health (95% confidence interval [CI] total sacrectomy 36-42 versus S4 50-64, p \ 0.001), less intense pain (95% CI total sacrectomy 47-60 versus S4 28-37, p \ 0.001), less interference resulting from pain (95% CI total sacrectomy 58-69 versus S4 36-51, p = 0.004), higher mobility (95% CI total sacrectomy 24-46 versus S4 59-59, p = 0.002), and were more functionally able to achieve orgasm (95% CI S1 1-1 versus S4 2.2-5.3, p = 0.043).

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“…All patients received high doses of radiation according to the previously described protocol [5]. The median radiation dose received by all patients was 70.2 Gy (range, 50.4-79.2 Gy) and was a combination of photons and protons [2,4]. In the surgical group, all patients received preoperative radiation (median dose, 50.4 Gy), and 40 of 44 patients (91%) received additional postoperative boost radiation per established protocol (median dose, 19.8 Gy).…”

Section: Patient Demographicsmentioning

confidence: 99%

“…In the spine, external beam radiation therapy combined with surgical resection has been shown to be an effective option for treatment of historically radiationresistant tumors [2,13]. We have combined surgery with high-dose proton-based radiation with good results, with 94% local tumor control at 5 years for chordomas and other malignant bone tumors in the sacrum [4]. We also have had good results after high-dose radiation alone: 80% local tumor control at 5 years in patients who elected nonsurgical treatment or patients who otherwise were not good surgical candidates [2].…”

Section: Introductionmentioning

confidence: 99%

Sacral Insufficiency Fractures are Common After High-dose Radiation for Sacral Chordomas Treated With or Without Surgery

Osler

Bredella

Hess

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Surgery with high-dose radiation and highdose radiation alone for sacral chordomas have shown promising local control rates. However, we have noted frequent sacral insufficiency fractures and perceived this rate to be higher than previously reported. Questions/purposes We wished (1) to characterize the incidence of sacral insufficiency fractures in patients with chordomas of the sacrum who received high-dose radiation, and (2) to determine whether patients treated with surgery plus high-dose radiation or high-dose radiation alone are more likely to experience a sacral fracture, and to compare time to fracture in these groups. Methods Sixty-two patients who received high-dose radiation for sacral chordomas with (n = 44) or without surgical resection (n = 18) between 1992 and 2013 were included in this retrospective study. At our institution, sacral chordomas generally are treated by preoperative radiotherapy, followed by en bloc resection, and postoperative radiotherapy. Radiation alone, with an intent to cure, is offered to patients who otherwise are not good surgical candidates or patients who elect radiotherapy based on tumor location and the anticipated morbidity after surgery (such as sexual, bowel, or bladder dysfunction). MRI and CT scans were evaluated for evidence of sacral insufficiency fractures. Complete followup was available at a minimum of 2 years (or until fracture or death) for all 18 patients who underwent radiation alone, whereas 14% (six of 44 patients) in the surgery plus radiation group (9% [three of 33] after high sacrectomy and 27% [three of 11] after low sacrectomy) were lost to followup before 2 years. Results Sacral insufficiency fractures occurred in 29 of the 62 patients (47%). A total of 25 of 33 patients (76%)One author (SJJ) certifies that he has received, an amount less than USD 10,000 from the Anna Foundation (Oegstgeest, The Netherlands), an amount less than USD 10,000 from the De Drie Lichten Foundation (Hilversum, The Netherlands), an amount less than USD 10,000 from the KWF Kankerbestrijding (Amsterdam, The Netherlands), and an amount less than USD10,000 from the Michael van Vloten Foundation (Rotterdam, The Netherlands). One author (JHS) certifies that he or a member of his family has or may receive payments or benefits, an amount less than USD 10,000 from Stryker (Kalamazoo, MI, USA), and an amount less than USD 10,000 from Biom'up (Saint-Priest, Lyon, France). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at Massachusetts General Hospital, Boston, MA, USA. with high sacrectomy had fractures develop compared with zero of 11 (0%) after low sacrectomy, and four of the 18 patients (22%) w...

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Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas

Cited by 238 publications

References 30 publications

High control rate in patients with chondrosarcoma of the skull base after carbon ion therapy: First report of long‐term results

High control rate in patients with chondrosarcoma of the skull base after carbon ion therapy: First report of long‐term results

How Does the Level of Sacral Resection for Primary Malignant Bone Tumors Affect Physical and Mental Health, Pain, Mobility, Incontinence, and Sexual Function?

Sacral Insufficiency Fractures are Common After High-dose Radiation for Sacral Chordomas Treated With or Without Surgery

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