Outcomes of Patients with Primary Sacral Chordoma Treated with Definitive Proton Beam Therapy

Publication date: Available online 21 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Norihiro Aibe, Yusuke Demizu, Nor Shazrina Sulaiman, Yoshirou Matsuo, Masayuki Mima, Fumiko Nagano, Kazuki Terashima, Sunao Tokumaru, Tomokatsu Hayakawa, Masaki Suga, Takashi Daimon, Gen Suzuki, Yamazaki Hideya, Kei Yamada, Ryohei Sasaki, Nobukazu Fuwa, Tomoaki Okimoto
PurposeTo evaluate the efficacy and safety of definitive proton beam therapy (PBT) for primary sacral chordoma.Methods and MaterialsWe conducted a retrospective analysis of the clinical outcomes of eligible patients with primary sacral chordoma who underwent definitive PBT with 70.4 Gy (relative biological effectiveness) in 32 fractions at our institution between September 2009 and October 2015. Local progression-free survival, distant metastasis-free survival, disease-free survival, cause-specific survival, and overall survival were evaluated. To explore the factors that influenced local progression, the following parameters were analyzed: sex, the presence of a spacer (GORE-TEX sheets), gross tumor volume (mL), and the extent of cranial tumor extension. Adverse events were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. To assess the impact of PBT on pain relief, the change in pain grades was investigated between the initiation of PBT and the last follow-up.ResultsThirty-three eligible patients were analyzed. The median follow-up period was 37 months. The 3-year estimated local progression-free survival, distant metastasis-free survival, disease-free survival, cause-specific survival, and overall survival rates were 89.6%, 88.2%, 81.9%, 95.7%, and 92.7%, respectively. There was no significant association between the patients' clinicopathological characteristics and local progression-free survival. Four patients developed Grade 3 adverse events, including acute dermatitis (n = 1), ileus (n = 1), and pain due to sacral insufficiency fractures (n = 2). The pain grades were improved, unchanged, or deteriorated in 15, 7, and 11 patients, respectively.ConclusionsDefinitive PBT with 70.4 Gy (relative biological effectiveness) in 32 fractions is an effective treatment with acceptable toxicity for primary sacral chordoma, and has the potential to reduce pain.

Teaser

We conducted a retrospective analysis to evaluate the safety and efficacy of definitive proton beam therapy with 70.4 Gy (relative biological effectiveness) in 32 fractions for primary sacral chordoma. This cohort study of 33 eligible patients shows that this treatment modality is safe and effective, and has the potential to reduce pain.


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