Prognostic impact of the "Sekhar grading system for cranial Chordomas" in patients treated with pencil beam scanning proton therapy: an institutional analysis.

Autor: Hottinger AL; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland., Bojaxhiu B; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland., Ahlhelm F; Neuroradiology Department, Kantonsspital Baden, Baden, Switzerland., Walser M; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland., Bachtiary B; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland., Zepter S; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland., Lomax T; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland.; Department of Physics, ETH Zürich, Zürich, Switzerland., Pica A; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland., Weber DC; Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland. damien.weber@psi.ch.; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland. damien.weber@psi.ch.; Radiation Oncology Department, University Hospital of Zürich, Zürich, Switzerland. damien.weber@psi.ch.
Jazyk: angličtina
Zdroj: Radiation oncology (London, England) [Radiat Oncol] 2020 May 06; Vol. 15 (1), pp. 96. Date of Electronic Publication: 2020 May 06.
DOI: 10.1186/s13014-020-01547-x
Abstrakt: Background: Skull base chordomas are rare and heterogeneously behaving tumors. Though still classified as benign they can grow rapidly, are locally aggressive, and have the potential to metastasize. To adapt the treatment to the specific needs of patients at higher risk of recurrence, a pre-proton therapy prognostic grading system would be useful. The aim of this retrospective analysis is to assess prognostic factors and the "Sekhar Grading System for Cranial Chordomas" (SGSCC) by evaluating the larger cohort of patients treated at our institution as to determine its reproducibility and ultimately to ensure more risk adapted local treatments for these challenging tumors.
Methods: We analyzed 142 patients treated for skull base chordomas between 2004 and 2016. We focused the analysis on the 5 criteria proposed for the SGSCC (tumor size, number of anatomic regions and vessels involved, intradural invasion, as well as recurrence after prior treatment) and classified our patients according to their score (based on the above mentioned criteria) into three prognostic groups, low-risk, intermediate-risk and high-risk. The three groups were then analyzed in regards of local control, local recurrence-free survival and overall survival.
Results: The median follow up was 52 months (range, 3-152). We observed 34 (24%) patients with a local recurrence, resulting in a local control of 75% at 5 years. Overall survival was 83% at 5 years, 12 (9%) patients had died due to local progression. When split into the three prognostic groups according to the SGSCC the observed local control was 90, 72 and 64% (p = 0.07) in the low-, intermediate- and high-risk group, respectively. A similar correlation was observed for local recurrence-free survival with 93, 89 and 66% (p = 0.05) and for overall survival with 89, 83 and 76% (p = 0.65) for the same prognostic groups.
Conclusions: After splitting our patient cohort into the three SGSCC risk groups, we found a trend towards better outcome for those patients with lower as opposed to higher scores. These results suggest that this prognostic grading system published by Sekhar et al. could be integrated in the management decision-tree for patients with skull base chordoma.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje