Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil.
Department of Spine Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil.
J Neurooncol. 2022 May;158(1):23-31. doi: 10.1007/s11060-022-04003-w. Epub 2022 Apr 22.
To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base.
Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure.
A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63).
Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.
报告高强度调强放疗（IG-IMRT）治疗骶骨、脊柱活动部和颅底脊索瘤的初步结果。
对单一三级癌症中心接受手术和/或放疗（RT）治疗的脊索瘤患者进行回顾性分析。初始治疗分为（A）辅助或根治性高剂量 RT（78 Gy/39fx 或 24 Gy/1fx）与（B）仅手术或低剂量 RT。主要终点是局部失败的累积发生率。
共纳入 2010 年至 2020 年期间治疗的 31 例患者。中位年龄为 55 岁，肿瘤位置为 64%骶骨、13%腰椎、16%颈椎和 6%颅底。中位肿瘤体积为 148 cc（最大直径为 8.3 cm），42%的患者接受了根治性手术，65%的患者接受了原发性 RT（辅助或根治性）。A 组 5 年局部失败累积发生率为 48%，B 组为 83%（p=0.041）。肿瘤体积＞330 cc 与局部失败相关（SHR 2.2，95%CI 1.12 至 7.45；p=0.028）。8 例患者发生远处转移，无转移生存中位数为 56.1 个月。接受高剂量 RT 的患者 5 年生存率为 72%，而未接受或低剂量 RT 的患者为 76%（p=0.63）。
我们的研究表明，高强度光子 IG-IMRT 可改善脊索瘤初始治疗中的局部控制。卫生系统应促进具有临床专业知识和技术能力的参考中心，以改善这种复杂疾病的结局。
