Rutz Hans Peter, Weber Damien C, Sugahara Shinji, Timmermann Beate, Lomax Antony J, Bolsi Alessandra, Pedroni Eros, Coray Adolf, Jermann Martin, Goitein Gudrun
Division of Radiation Medicine, Paul Scherrer Institute, Villigen, Switzerland.
Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):512-20. doi: 10.1016/j.ijrobp.2006.08.052. Epub 2006 Nov 2.
To evaluate the use of postoperative proton therapy (PT) in extracranial chordoma.
Twenty-six patients were treated. Gross total resection was achieved in 18 patients. Nine patients had cervical, 2 had thoracic, 8 had lumbar, and 7 had sacro-coccygeal chordomas. Thirteen patients had implants. PT was administered after function-preserving surgery, using a gantry and spot scanning, without or with intensity modulation (IMPT; 6 patients), and/or photon-based radiotherapy (RT, 6 patients). Median total dose was 72 cobalt Gray equivalent (CGE; range, 59.4-74.4), with means of 70.5 and 73.2 CGE for patients with and without implants. Median follow-up time was 35 months (range, 13-73 months). Adverse events were scored using the Common Terminology Criteria for Adverse Events grading system (version 3.0).
At 3 years, actuarial overall survival (OS) and progression-free survival (PFS) rates were 84% and 77%, respectively. One patient each died of local failure (LF), distant failure (DF), suicide, and secondary tumor. We observed 5 LFs and 3 DFs; 3-year LF-free and DF-free survival rates were 86%. We observed four radiation-induced late adverse events (Grade 2 sensory neuropathy; Grade 3 subcutaneous necrosis, and osteonecrosis; and Grade 5 secondary cancer). In univariate analysis, implants were associated with LF (p = 0.034). Gross residual tumor above 30 mL was negatively associated with OS (p = 0.013) and PFS (p = 0.025).
Postoperative PT for extracranial chordomas delivered with spot scanning offers high local control rates. Toxicity was acceptable. Implants were significantly associated with LF. Residual tumor above 30 mL impacted negatively on OS and PFS.
评估术后质子治疗（PT）在颅外脊索瘤中的应用。
共治疗26例患者。18例患者实现了肉眼全切。9例患者患有颈椎脊索瘤，2例患有胸椎脊索瘤，8例患有腰椎脊索瘤，7例患有骶尾脊索瘤。13例患者植入了粒子。PT在保功能手术后进行，采用机架和点扫描，未进行或进行了调强质子治疗（IMPT；6例患者），和/或基于光子的放射治疗（RT，6例患者）。中位总剂量为72钴灰当量（CGE；范围59.4 - 74.4），植入粒子和未植入粒子的患者平均剂量分别为70.5和73.2 CGE。中位随访时间为35个月（范围13 - 73个月）。不良事件采用不良事件通用术语标准分级系统（第3.0版）进行评分。
3年时，精算总生存率（OS）和无进展生存率（PFS）分别为84%和77%。各有1例患者死于局部复发（LF）、远处转移（DF）、自杀和继发肿瘤。我们观察到5例LF和3例DF；3年无LF和无DF生存率为86%。我们观察到4例放射诱发的晚期不良事件（2级感觉神经病变；3级皮下坏死和骨坏死；5级继发癌症）。单因素分析显示，植入粒子与LF相关（p = 0.034）。大于30 mL的大体残留肿瘤与OS（p = 0.013）和PFS（p = 0.025）呈负相关。
采用点扫描进行术后PT治疗颅外脊索瘤可提供较高的局部控制率。毒性可接受。植入粒子与LF显著相关。大于30 mL的残留肿瘤对OS和PFS有负面影响。
