BACKGROUND: Negative surgical margins are uncommon for spine sarcomas; hence, adjuvant radiotherapy (RT) may be recommended but tumor dose may be constrained by spinal cord, nerve, and viscera tolerance. METHODS: Prospective Phase II clinical trial incorporating high dose RT. Eligible patients had primary or locally recurrent thoracic, lumbar, and/or sacral spine/paraspinal chordomas or sarcomas. Treatment included pre- and/or post-operative photon/proton RT ± radical resection. RESULTS: Fifty patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n = 25) or subtotal (n = 12) resection or biopsy (n = 13). RT dose was ≤72.0 GyRBE in 25 patients and 76.6-77.4 GyRBE in 25 patients. With 7.3-year median follow-up, the 5 and 8-year actuarial local control (LC) rates were 94% and 85% for primary tumors and 81% and 74% for the entire group. Local recurrence was less common for primary tumors, 4/36 (11%) versus 7/14 (50%) for recurrent tumors, P = 0.002. The 8-year actuarial risk of grade 3-4 late RT morbidity was 13%. No myelopathies were seen. No late neurologic toxicities noted with radiation doses ≤72.0 GyRBE while three sacral neuropathies appeared after doses of 76.6-77.4 GyRBE. CONCLUSIONS: LC with this treatment is high in patients with primary tumors. Late morbidity appears to be acceptable.
BACKGROUND: Negative surgical margins are uncommon for spine sarcomas; hence, adjuvant radiotherapy (RT) may be recommended but tumor dose may be constrained by spinal cord, nerve, and viscera tolerance. METHODS: Prospective Phase II clinical trial incorporating high dose RT. Eligible patients had primary or locally recurrent thoracic, lumbar, and/or sacral spine/paraspinal chordomas or sarcomas. Treatment included pre- and/or post-operative photon/proton RT ± radical resection. RESULTS: Fifty patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n = 25) or subtotal (n = 12) resection or biopsy (n = 13). RT dose was ≤72.0 GyRBE in 25 patients and 76.6-77.4 GyRBE in 25 patients. With 7.3-year median follow-up, the 5 and 8-year actuarial local control (LC) rates were 94% and 85% for primary tumors and 81% and 74% for the entire group. Local recurrence was less common for primary tumors, 4/36 (11%) versus 7/14 (50%) for recurrent tumors, P = 0.002. The 8-year actuarial risk of grade 3-4 late RT morbidity was 13%. No myelopathies were seen. No late neurologic toxicities noted with radiation doses ≤72.0 GyRBE while three sacral neuropathies appeared after doses of 76.6-77.4 GyRBE. CONCLUSIONS: LC with this treatment is high in patients with primary tumors. Late morbidity appears to be acceptable.
Authors: Matthew T Houdek; Peter S Rose; Mario Hevesi; Joseph H Schwab; Anthony M Griffin; John H Healey; Ivy A Petersen; Thomas F DeLaney; Peter W Chung; Michael J Yaszemski; Jay S Wunder; Francis J Hornicek; Patrick J Boland; Franklin H Sim; Peter C Ferguson Journal: J Surg Oncol Date: 2019-02-07 Impact factor: 3.454
Authors: Chetan Bettegowda; Stephen Yip; Sheng-Fu Larry Lo; Charles G Fisher; Stefano Boriani; Laurence D Rhines; Joanna Y Wang; Aron Lazary; Marco Gambarotti; Wei-Lien Wang; Alessandro Luzzati; Mark B Dekutoski; Mark H Bilsky; Dean Chou; Michael G Fehlings; Edward F McCarthy; Nasir A Quraishi; Jeremy J Reynolds; Daniel M Sciubba; Richard P Williams; Jean-Paul Wolinsky; Patricia L Zadnik; Ming Zhang; Niccole M Germscheid; Vasiliki Kalampoki; Peter Pal Varga; Ziya L Gokaslan Journal: Neuro Oncol Date: 2017-03-01 Impact factor: 12.300