使用质子或碳离子的粒子疗法治疗不可切除或未完全切除的骨盆骨肉瘤和软组织肉瘤。

Particle Therapy Using Protons or Carbon Ions for Unresectable or Incompletely Resected Bone and Soft Tissue Sarcomas of the Pelvis.

作者信息

Demizu Yusuke, Jin Dongcun, Sulaiman Nor Shazrina, Nagano Fumiko, Terashima Kazuki, Tokumaru Sunao, Akagi Takashi, Fujii Osamu, Daimon Takashi, Sasaki Ryohei, Fuwa Nobukazu, Okimoto Tomoaki

机构信息

Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan.

出版信息

Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):367-374. doi: 10.1016/j.ijrobp.2017.02.030. Epub 2017 Feb 22.

DOI:10.1016/j.ijrobp.2017.02.030

PMID:28463156

Abstract

PURPOSE

To retrospectively analyze the treatment outcomes of particle therapy using protons or carbon ions for unresectable or incompletely resected bone and soft tissue sarcomas (BSTSs) of the pelvis.

METHODS AND MATERIALS

From May 2005 to December 2014, 91 patients with nonmetastatic histologically proven unresectable or incompletely resected pelvic BSTSs underwent particle therapy with curative intent. The particle therapy used protons (52 patients) or carbon ions (39 patients). All patients received a dose of 70.4 Gy (relative biologic effectiveness) in 32 fractions (55 patients) or 16 fractions (36 patients).

RESULTS

The median patient age was 67 years (range 18-87). The median planning target volume (PTV) was 455 cm (range 108-1984). The histologic type was chordoma in 53 patients, chondrosarcoma in 14, osteosarcoma in 10, malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma in 5, and other in 9 patients. Of the 91 patients, 82 had a primary tumor and 9 a recurrent tumor. The median follow-up period was 32 months (range 3-112). The 3-year rate of overall survival (OS), progression-free survival (PFS), and local control was 83%, 72%, and 92%, respectively. A Cox proportional hazards model revealed that chordoma histologic features and a PTV of ≤500 cm were significantly associated with better OS, and a primary tumor and PTV of ≤500 cm were significantly associated with better PFS. Ion type and number of fractions were not significantly associated with OS, PFS, or local control. Late grade ≥3 toxicities were observed in 23 patients. Compared with the 32-fraction protocol, the 16-fraction protocol was associated with significantly more frequent late grade ≥3 toxicities (18 of 36 vs 5 of 55; P<.001).

CONCLUSIONS

Particle therapy using protons or carbon ions was effective for unresectable or incompletely resected pelvic BSTS, and the 32-fraction protocol was effective and relatively less toxic. Nevertheless, a longer follow-up period is needed to confirm these results.

摘要

目的

回顾性分析使用质子或碳离子粒子疗法治疗不可切除或未完全切除的骨盆骨肉瘤和软组织肉瘤（BSTSs）的治疗效果。

方法和材料

2005年5月至2014年12月，91例经组织学证实为非转移性、不可切除或未完全切除的骨盆BSTSs患者接受了根治性粒子疗法。粒子疗法使用质子（52例患者）或碳离子（39例患者）。所有患者接受70.4 Gy（相对生物效应）的剂量，分32次（55例患者）或16次（36例患者）给予。

结果

患者中位年龄为67岁（范围18 - 87岁）。中位计划靶体积（PTV）为455 cm³（范围108 - 1984 cm³）。组织学类型为脊索瘤53例，软骨肉瘤14例，骨肉瘤10例，恶性纤维组织细胞瘤/未分化多形性肉瘤5例，其他9例。91例患者中，82例为原发性肿瘤，9例为复发性肿瘤。中位随访期为32个月（范围3 - 112个月）。3年总生存率（OS）、无进展生存率（PFS）和局部控制率分别为83%、72%和92%。Cox比例风险模型显示，脊索瘤组织学特征和PTV≤500 cm³与较好的OS显著相关，原发性肿瘤和PTV≤500 cm³与较好的PFS显著相关。离子类型和分次次数与OS、PFS或局部控制无显著相关性。23例患者观察到≥3级晚期毒性反应。与32分次方案相比，16分次方案≥3级晚期毒性反应更频繁（36例中的18例 vs 55例中的5例；P <.001）。