Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland; Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
Int J Radiat Oncol Biol Phys. 2018 May 1;101(1):226-233. doi: 10.1016/j.ijrobp.2018.01.060. Epub 2018 Feb 2.
To evaluate the efficacy and safety of high-dose pencil-beam scanning proton therapy (PBS-PT) in the adjuvant treatment of spinal chordomas.
Between 1997 and 2015, 100 patients with spinal chordomas (median age, 56 years; range, 25-81 years) were treated with adjuvant PBS-PT at the Paul Scherrer Institute: cervical (n = 46), thoracic (n = 4), lumbar (n = 12), and sacral (n = 38). The majority (88%) received PBS-PT alone rather than combined photon-proton therapy. The median radiation therapy dose prescribed was 74 Gy (relative biological effectiveness [RBE]) (range, 59.4-77 Gy [RBE]). Thirty-nine patients (39%) had undergone surgical stabilization, primarily with titanium hardware, before radiation therapy.
With a median follow-up of 65 months (range, 13-175 months), 5-year local control, disease control, and overall survival rates were 63% (95% confidence interval [CI] 57.7-68.7%; median, 103 months), 57% (95% CI 50.9-62.1%; median, 82 months), and 81% (95% CI 76.8-85.6%; median, 157 months), respectively. On univariate and multivariate analyses, the presence of surgical stabilization was highly prognostic for worsened outcomes. Multivariate analysis also revealed the extent of treatment volumes and presence of gross residual disease to be important in predicting outcomes. High-grade (grade ≥3) toxicities were rare in both the acute (8%) and late (6%) settings.
For spinal chordomas, PBS-PT remains a highly effective and safe method for delivery of dose-escalated adjuvant radiation therapy. The presence of metallic surgical stabilization prognosticates for worsened outcomes. Further investigation is warranted to characterize ideal treatment volumes and effect of surgical stabilization on therapy for these challenging tumors.
评估高剂量笔形束扫描质子治疗（PBS-PT）在脊索瘤辅助治疗中的疗效和安全性。
1997 年至 2015 年期间，在保罗谢勒研究所（Paul Scherrer Institute），有 100 例脊索瘤患者（中位年龄 56 岁；范围 25-81 岁）接受了辅助 PBS-PT 治疗：颈椎（n=46）、胸椎（n=4）、腰椎（n=12）和骶骨（n=38）。大多数患者（88%）接受了单纯的 PBS-PT 治疗，而不是光子-质子联合治疗。规定的中位放射治疗剂量为 74 Gy（相对生物效应[RBE]）（范围 59.4-77 Gy [RBE]）。39 例患者（39%）在放疗前接受了手术稳定，主要采用钛合金硬件。
中位随访 65 个月（范围 13-175 个月）后，5 年局部控制率、疾病控制率和总生存率分别为 63%（95%置信区间[CI] 57.7-68.7%；中位 103 个月）、57%（95% CI 50.9-62.1%；中位 82 个月）和 81%（95% CI 76.8-85.6%；中位 157 个月）。单因素和多因素分析显示，手术稳定的存在与较差的预后高度相关。多因素分析还显示，治疗体积的大小和大体残留疾病的存在是预测结果的重要因素。急性（8%）和迟发性（6%）毒性均为高级别（≥3 级）毒性罕见。
对于脊索瘤，PBS-PT 仍然是一种非常有效的、安全的方法，可用于递增强度调整的辅助放射治疗。金属手术稳定的存在预示着预后较差。需要进一步研究以确定理想的治疗体积和手术稳定对这些挑战性肿瘤治疗的影响。
