James W Snider1, Ralf A Schneider2, Davey Poelma-Tap3, Sonja Stieb4, Fritz R Murray2, Lorenzo Placidi2, Francesca Albertini2, Antony Lomax2, Alessandra Bolsi2, Ulrike Kliebsch2, Robert Malyapa5, Damien C Weber6. 1. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland; Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. 2. Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. 3. Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; Radiotherapeutisch Instituut Friesland, Leeuwarden, The Netherlands. 4. Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; Universitätsklinik für Radio-Onkologie, Inselspital Universitatsspital Bern, Bern, Switzerland. 5. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland. 6. Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; University of Bern, Bern, Switzerland; University of Zürich, Zürich, Switzerland. Electronic address: damien.weber@psi.ch.
Abstract
PURPOSE: To evaluate the efficacy and safety of high-dose pencil-beam scanning proton therapy (PBS-PT) in the adjuvant treatment of spinal chordomas. METHODS AND MATERIALS: 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. RESULTS: 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. CONCLUSION: 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.
PURPOSE: To evaluate the efficacy and safety of high-dose pencil-beam scanning proton therapy (PBS-PT) in the adjuvant treatment of spinal chordomas. METHODS AND MATERIALS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Neil G Burnet; Ranald I Mackay; Ed Smith; Amy L Chadwick; Gillian A Whitfield; David J Thomson; Matthew Lowe; Norman F Kirkby; Adrian M Crellin; Karen J Kirkby Journal: Br J Radiol Date: 2020-01-14 Impact factor: 3.039
Authors: Sabah Falek; Rajesh Regmi; Joel Herault; Melanie Dore; Anthony Vela; Pauline Dutheil; Cyril Moignier; Pierre-Yves Marcy; Julien Drouet; Arnaud Beddok; Noah E Letwin; Joel Epstein; Upendra Parvathaneni; Juliette Thariat Journal: Support Care Cancer Date: 2022-05-05 Impact factor: 3.359
Authors: Sara Rosas; Francesca M Belosi; Nicola Bizzocchi; Till Böhlen; Stefan Zepter; Petra Morach; Antony J Lomax; Damien C Weber; Jan Hrbacek Journal: Br J Radiol Date: 2020-01-30 Impact factor: 3.039
Authors: Cristina Müller; Maria De Prado Leal; Marco D Dominietto; Christoph A Umbricht; Sairos Safai; Rosalind L Perrin; Martina Egloff; Peter Bernhardt; Nicholas P van der Meulen; Damien C Weber; Roger Schibli; Antony J Lomax Journal: Pharmaceutics Date: 2019-09-02 Impact factor: 6.321
Authors: Birgit S Müller; Yu-Mi Ryang; Markus Oechsner; Mathias Düsberg; Bernhard Meyer; Stephanie E Combs; Jan J Wilkens Journal: J Appl Clin Med Phys Date: 2020-05-31 Impact factor: 2.102
Authors: Liyong Lin; Paige A Taylor; Jiajian Shen; Jatinder Saini; Minglei Kang; Charles B Simone; Jeffrey D Bradley; Zuofeng Li; Ying Xiao Journal: Int J Part Ther Date: 2021-05-25