High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes.

Autor: Chen ATC; Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil. andre.chen@hc.fm.usp.br., Hong CBC; Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil., Narazaki DK; Department of Spine Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil., Rubin V; Department of Radiology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil., Serante AR; Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil., Ribeiro Junior U; Department of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil., de Lima LGCA; Department of Pathology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil., Coimbra BGMM; Department of Spine Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil., Cristante AF; Department of Spine Surgery of Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil., Teixeira WGJ; Department of Spine Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Journal of neuro-oncology [J Neurooncol] 2022 May; Vol. 158 (1), pp. 23-31. Date of Electronic Publication: 2022 Apr 22.
DOI: 10.1007/s11060-022-04003-w
Abstrakt: Purpose: To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base.
Methods: Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure.
Results: A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63).
Conclusion: Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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