Beddok Arnaud, Saint-Martin Caroline, Mammar Hamid, Feuvret Loïc, Helfre Sylvie, Bolle Stéphanie, Froelich Sebastien, Goudjil Farid, Zefkili Sofia, Amessis Malika, Peurien Dominique, Cornet Sophie, Dendale Rémi, Alapetite Claire, Calugaru Valentin
Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France.
Department of Radiation oncology, Curie Institute, Paris, France.
Acta Oncol. 2021 Feb;60(2):245-251. doi: 10.1080/0284186X.2020.1834140. Epub 2020 Oct 23.
Radiation therapy (RT) is used for the treatment of sacral chordoma, in combination with surgery or alone for unresected tumours, to improve local control (LC) and potentially overall survival (OS). The purpose of the present study was to evaluate efficacy and toxicity of proton therapy (PT), and/or intensity modulated radiation therapy (IMRT), particularly Tomotherapy, for sacral chordoma treatment. Between November 2005 and June 2018, 41 consecutive patients who were not included in clinical trials, received sacral chordoma radiation treatment in Institut Curie with Tomotherapy alone in 13 patients, and combined PT and Tomotherapy boost (Proton - Tomo) in 28 patients. RT was delivered as the exclusive local treatment in 11 patients, and as a post-operative complementary treatment in 30 patients.
After a median follow-up of 46 months (range, 0-125 months), eight local relapses were observed, and seven patients developed distant metastasis (particularly bone and lung). The 2- and 5- year local relapse rates were 11.4% CI (0.65-22.2%) and 29% (10.5-47.4%), respectively. Over the follow-up period, ten patients died (24.4%). The estimated 2- and 5-year OS rates were 91.4% CI (82.5-100%) and 74.5% (59.4-93.5%), respectively. Fibrosis, syndrome, and pain were the most common late toxicities. The comparison between Tomotherapy alone and Proton - Tomo revealed that acute and late cystitis were significantly more frequent in the Tomotherapy group: SHR = 0.12 IC95% (0.01-0.90 [ = .04]), as well as late proctitis. A dosimetric comparison confirmed the interest of PT to spare rectum and bladder in this context.
RT remains essential to improve local control in sacral chordoma. The combination of proton and photon seems to improve organ at risk sparing, resulting in a decreased rate of reported late toxicities.
放射治疗（RT）用于骶骨脊索瘤的治疗，可与手术联合使用，或单独用于无法切除的肿瘤，以提高局部控制率（LC）并可能改善总生存期（OS）。本研究的目的是评估质子治疗（PT）和/或调强放射治疗（IMRT），特别是螺旋断层放疗，用于骶骨脊索瘤治疗的疗效和毒性。2005年11月至2018年6月期间，41例未纳入临床试验的患者在居里研究所接受了骶骨脊索瘤放射治疗，其中13例仅接受螺旋断层放疗，28例接受质子治疗联合螺旋断层放疗增强（质子-螺旋断层放疗）。RT作为唯一的局部治疗方法用于11例患者，作为术后辅助治疗用于30例患者。
中位随访46个月（范围0-125个月）后，观察到8例局部复发，7例患者发生远处转移（尤其是骨和肺转移）。2年和5年局部复发率分别为11.4% CI（0.65-22.2%）和29%（10.5-47.4%）。在随访期间，10例患者死亡（24.4%）。估计的2年和5年总生存率分别为91.4% CI（82.5-100%）和74.5%（59.4-93.5%）。纤维化、综合征和疼痛是最常见的晚期毒性反应。单纯螺旋断层放疗组与质子-螺旋断层放疗组的比较显示，螺旋断层放疗组急性和晚期膀胱炎明显更常见：标准化发病比（SHR）=0.12，95%置信区间（IC95%）为（0.01-0.90 [=0.04]），晚期直肠炎也是如此。剂量学比较证实了在这种情况下质子治疗对保护直肠和膀胱的益处。
放射治疗对于提高骶骨脊索瘤的局部控制率仍然至关重要。质子和光子联合治疗似乎可以改善对危险器官的保护，从而降低报告的晚期毒性反应发生率。
