Holtzman Adam L, Rotondo Ronny L, Rutenberg Michael S, Indelicato Daniel J, De Leo Alexandra, Rao Dinesh, Patel Jeet, Morris Christopher G, Mendenhall William M
Department of Radiation Oncology University of Florida College of Medicine, Jacksonville, FL, USA.
Department of Radiation Oncology, University of Kansas, Kansas City, KS, USA.
Int J Part Ther. 2021 Jun 25;8(1):179-188. doi: 10.14338/IJPT-20-00066.1. eCollection 2021 Summer.
To evaluate the effectiveness of external-beam proton therapy (PT) on local control and survival in patients with skull-base chordoma.
We reviewed the medical records of patients with skull-base chordoma treated with definitive or adjuvant high-dose PT and updated their follow-up when feasible. We assessed overall survival, disease-specific survival, local control, and freedom from distant metastasis. Radiotherapy toxicities were scored using the Common Terminology Criteria for Adverse Events, version 4.0.
A total 112 patients were analyzed, of whom 105 (94%) received PT and 7 (6%) received combined proton-photon therapy between 2007 and 2019. Eighty-seven patients (78%) underwent a subtotal resection, 22 (20%) a gross total resection, and 3 (3%) a biopsy alone. The median radiotherapy dose was 73.8 Gy radiobiologic equivalent (GyRBE; range, 69.6-74.4). Ninety patients (80%) had gross disease at radiotherapy and 7 (6%) were treated for locally recurrent disease following surgery. Median follow-up was 4.4 years (range, 0.4-12.6); for living patients, it was 4.6 years (range, 0.4-12.6), and for deceased patients, 4.1 years (range, 1.2-11.2). At 5 years after radiotherapy, the actuarial overall survival, disease-specific survival, local control, and freedom from distant metastasis rates were 78% (n = 87), 83% (n = 93), 74% (n = 83), and 99% (n = 111), respectively. The median time to local progression was 2.4 years (range, 0.8-7). Local control and disease-specific survival by resection status was 95% versus 70% ( = 0.28) and 100% versus 80% ( = 0.06) for gross total, versus subtotal, resection or biopsy alone, respectively. There were no serious acute toxicities (grade ≥ 3) related to radiotherapy.
High-dose PT alone or after surgical resection for skull-base chordoma reaffirms the favorable 5-year actuarial local control rate compared with conventional techniques with acceptable late-complication-free survival. Outcomes following gross total resection and adjuvant PT were excellent. Further follow-up of this cohort is necessary to better characterize long-term disease control and late toxicities.
评估外照射质子治疗（PT）对颅底脊索瘤患者局部控制和生存的有效性。
我们回顾了接受根治性或辅助性高剂量PT治疗的颅底脊索瘤患者的病历，并在可行时更新其随访情况。我们评估了总生存期、疾病特异性生存期、局部控制情况以及无远处转移情况。使用不良事件通用术语标准4.0版对放疗毒性进行评分。
共分析了112例患者，其中105例（94%）在2007年至2019年间接受了PT治疗，7例（6%）接受了质子 - 光子联合治疗。87例（78%）患者接受了次全切除，22例（20%）接受了全切除，3例（3%）仅接受了活检。放疗的中位剂量为73.8 Gy生物等效剂量（GyRBE；范围为69.6 - 74.4）。90例（80%）患者在放疗时有肉眼可见的肿瘤，7例（6%）患者在手术后接受了局部复发病灶的治疗。中位随访时间为4.4年（范围为0.4 - 12.6年）；对于存活患者，为4.6年（范围为0.4 - 12.6年），对于死亡患者，为4.1年（范围为1.2 - 11.2年）。放疗后5年，精算总生存率、疾病特异性生存率、局部控制率和无远处转移率分别为78%（n = 87）、83%（n = 93）、74%（n = 83）和99%（n = 111）。局部进展的中位时间为2.4年（范围为0.8 - 7年）。全切除、次全切除或仅活检患者的局部控制率和疾病特异性生存率分别为95%对70%（P = 0.28）和100%对80%（P = 0.06）。没有与放疗相关的严重急性毒性反应（≥3级）。
单独使用高剂量PT或在颅底脊索瘤手术切除后使用，与传统技术相比，再次证实了良好的5年精算局部控制率，且无并发症的晚期生存率可接受。全切除并辅助PT后的效果极佳。有必要对该队列进行进一步随访，以更好地描述长期疾病控制情况和晚期毒性反应。
