Proton therapy for skull-base chondrosarcoma, a single-institution outcomes study

Holtzman, Adam L.; Rotondo, Ronny L.; Rutenberg, M.S.; Indelicato, Daniel J.; Mercado, Catherine E.; Rao, Dinesh; Tavanaiepour, Daryoush; Morris, Christopher G.; Louis, Debbie; Flampouri, Stella; Mendenhall, William M.

doi:10.1007/s11060-019-03129-8

Cited by 42 publications

(34 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Carbon ions with high linear energy transfer cause hardly reparable complex DNA double-strand break that may overcome the radioresistance of tumor cells [ 147 ]. Both proton and carbon ion radiotherapy provide reasonable local control and patients’ survival rates with acceptable toxicity [ 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 ]. There is one ongoing prospective randomized phase III clinical trial that aims to compare the local efficacy of proton and carbon ion therapy in patients with low and intermediate-grade CHSs of the skull base (NCT01182753).…”

Section: Radiotherapy In Chondrosarcomamentioning

confidence: 99%

Chondrosarcoma-from Molecular Pathology to Novel Therapies

Zając

Kopeć

Szostakowski

et al. 2021

Cancers

View full text Add to dashboard Cite

Chondrosarcoma (CHS) is the second most common primary malignant bone sarcoma. Overall survival and prognosis of this tumor are various and often extreme, depending on histological grade and tumor subtype. CHS treatment is difficult, and surgery remains still the gold standard due to the resistance of this tumor to other therapeutic options. Considering the role of differentiation of CHS subtypes and the need to develop new treatment strategies, in this review, we introduced a multidisciplinary characterization of CHS from its pathology to therapies. We described the morphology of each subtype with the role of immunohistochemical markers in diagnostics of CHS. We also summarized the most frequently mutated genes and genome regions with altered pathways involved in the pathology of this tumor. Subsequently, we discussed imaging methods and the role of currently used therapies, including surgery and the limitations of chemo and radiotherapy. Finally, in this review, we presented novel targeted therapies, including those at ongoing clinical trials, which can be a potential future target in designing new therapeutics for patients with CHS.

show abstract

Section: Radiotherapy In Chondrosarcomamentioning

confidence: 99%

Chondrosarcoma-from Molecular Pathology to Novel Therapies

Zając

Kopeć

Szostakowski

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…Nevertheless, as previous studies have demonstrated, the probability of debilitating complications is generally low, and favorable tumor control should be expected. [10,14,21] Simon et al reported that complications graded as CTCAE grade 3 or higher were observed in 25% after proton beam radiation and found that upfront proton beam radiation (as opposed to surgery alone) was associated with an increased risk of treatment-related complications. [12] Notwithstanding, not all CTCAE grade 3 complications are debilitating, as seen in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…These facts, in combination with a lack of effective chemotherapy, and the relatively abundant experience with radiotherapy, [13][14][15][16][17][18][19] often lead physicians to recommend upfront radiotherapy following resection.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of grade I/II skull base chondrosarcoma: an insight into the role of surgery and upfront radiotherapy

Hasegawa

Vakharia

Graffeo

et al. 2021

Preprint

View full text Add to dashboard Cite

PurposeTo clarify the need for post-operative radiation treatment in skull base chondrosarcomas (SBCs).MethodsA retrospective analysis of patients with grade I or II SBC. Patients were divided according to post-surgical treatment strategies: (A) planned upfront radiotherapy and (B) watchful waiting. Tumor control and survival were compared between the treatment groups. The median follow-up after resection was 105 months (range, 9-376).ResultsThirty-two patients (Grade 1, n = 16; Grade 2, n = 16) were included. The most frequent location was petroclival (21, 64%). A gross total resection (GTR) was achieved in 11 patients (34%). Fourteen (44%) underwent upfront radiotherapy (group A) whereas 18 (56%) were followed with serial MRI alone (group B). The tumor control rate for the entire group was 77% and 69% at 10- and 15-year, respectively. Upfront radiotherapy (P = 0.25), extent of resection (P = 0.11) or tumor grade (P = 0.83) did not affect tumor control. The majority of Group B patients with recurrent tumors (5/7) obtained tumor control with repeat resection (n = 2), salvage radiotherapy (n = 2), or a combination of both (n = 1). The 10-year disease-specific survival was 95% with no difference between the group A and B (P = 0.50). ConclusionFor patients with grade I/II SBC, a reasonable strategy is deferral of radiotherapy after maximum safe resection until tumor progression or recurrence. At that time, most patients can be successfully managed with salvage radiotherapy or surgery. Late recurrences may occur, and life-long follow-up is advisable.

show abstract

“…Although our follow-up is somewhat limited, a recent series on chordomas from Florida demonstrated a 14% rate of local recurrence at two years [ 19 ], suggesting that early local failures do occur and lending significant promise to our outcomes thus far. Conversely, a report from the same institution on skull-base chondrosarcomas demonstrated 100% local control at two years, with 89% local control by four years with a median follow-up of 3.7 years [ 20 ]. These differences likely reflect the more aggressive local nature of chordomas compared to chondrosarcomas.…”

Section: Discussionmentioning

confidence: 99%

Proton Therapy for Skull-Base Chordomas and Chondrosarcomas: Initial Results From the Beaumont Proton Therapy Center

Parzen¹,

Li²,

Zheng³

et al. 2021

Cureus

View full text Add to dashboard Cite

Background:Skull-base chordomas and chondrosarcomas are rare tumors that arise directly adjacent to important critical structures. Appropriate management consists of maximal safe resection followed by postoperative dose-escalated radiation therapy. Proton beam therapy is often employed in this context to maximize the sparing of organs at risk, such as the brainstem and optic apparatus. Methods: This is a single-institutional experience treating skull-base chordomas and chondrosarcomas with postoperative pencil beam scanning proton therapy. We employed a simultaneous integrated boost to the gross tumor volume (GTV) for increased conformality. Demographic, clinicopathologic, toxicity, and dosimetry information were collected. Toxicity was assessed according to Common Terminology Criteria for Adverse Events (CTCAE), v. 4.0. Results: Between 2017 and 2020, 13 patients were treated with postoperative proton therapy. There were 10 patients with chordoma (77%) and three with chondrosarcoma (23%). A gross total resection was achieved in six (60%) patients with chordoma and one patient with chondrosarcoma (33%). Nine patients (69%) received postoperative therapy, whereas four (31%) received treatment at recurrence/progression following re-excision. The median dose to the GTV was 72.4 cobalt-Gray equivalents (range, 70.0 to 75.8). The mean GTV was 3.4 cc (range, 0.2-38.7). There were no grade 3 or greater toxicities. One patient developed grade 2 temporal lobe necrosis. At 10.7 months' median follow-up (range, 2.1-30.6), the rates of local control and overall survival were 100%. Conclusions: Proton beam therapy with pencil beam scanning and simultaneous integrated boost to the GTV affords excellent early local control with the suggestion of low morbidity. This method deserves consideration as an optimal method for limiting dose to adjacent organs at risk and delivering clinically effective doses to the treatment volume.

show abstract

Proton therapy for skull-base chondrosarcoma, a single-institution outcomes study

Cited by 42 publications

References 33 publications

Chondrosarcoma-from Molecular Pathology to Novel Therapies

Chondrosarcoma-from Molecular Pathology to Novel Therapies

Long-term outcomes of grade I/II skull base chondrosarcoma: an insight into the role of surgery and upfront radiotherapy

Proton Therapy for Skull-Base Chordomas and Chondrosarcomas: Initial Results From the Beaumont Proton Therapy Center

Contact Info

Product

Resources

About