Matthias Mattke1,2,3,4, Matteo Ohlinger5,6, Nina Bougatf5,6,7,8, Semi Harrabi5,6, Robert Wolf5,6, Katharina Seidensaal5,6, Thomas Welzel5,6, Falk Röder9, Sabine Gerum9, Malte Ellerbrock6,8, Oliver Jäkel5,6,7,8, Thomas Haberer6,8, Klaus Herfarth5,6,8, Matthias Uhl10, Jürgen Debus5,6,11,7,8,12. 1. Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria. m.mattke@salk.at. 2. Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany. m.mattke@salk.at. 3. Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany. m.mattke@salk.at. 4. , Müllner Hauptstr. 48, 5020, Salzburg, Austria. m.mattke@salk.at. 5. Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany. 6. Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany. 7. Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. 8. Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany. 9. Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria. 10. Department of Radiation Oncology, Ludwigshafen Hospital, Bremserstr. 79, 67063, Ludwigshafen, Germany. 11. National Center for Tumor diseases (NCT), Heidelberg, Germany. 12. German Cancer Consortium (DKTK), Heidelberg, Germany.
Abstract
BACKGROUND: This study aimed to compare the results of irradiation with protons versus irradiation with carbon ions in a raster scan technique in patients with skull base chordomas and to identify risk factors that may compromise treatment results. METHODS: A total of 147 patients (85 men, 62 women) were irradiated with carbon ions (111 patients) or protons (36 patients) with a median dose of 66 Gy (RBE (Relative biological effectiveness); carbon ions) in 4 weeks or 74 Gy (RBE; protons) in 7 weeks at the Heidelberg Ion Beam Therapy Center (HIT) in Heidelberg, Germany. The median follow-up time was 49.3 months. All patients had gross residual disease at the beginning of RT. Compression of the brainstem was present in 38%, contact without compression in 18%, and no contact but less than 3 mm distance in 16%. Local control and overall survival were evaluated using the Kaplan-Meier Method based on scheduled treatment (protons vs. carbon ions) and compared via the log rank test. Subgroup analyses were performed to identify possible prognostic factors. RESULTS: During the follow-up, 41 patients (27.9%) developed a local recurrence. The median follow-up time was 49.3 months (95% CI: 40.8-53.8; reverse Kaplan-Meier median follow-up time 56.3 months, 95% CI: 51.9-60.7). No significant differences between protons and carbon ions were observed regarding LC, OS, or overall toxicity. The 1‑year, 3‑year, and 5‑year LC rates were 97%, 80%, and 61% (protons) and 96%, 80%, and 65% (carbon ions), respectively. The corresponding OS rates were 100%, 92%, and 92% (protons) and 99%, 91%, and 83% (carbon ions). No significant prognostic factors for LC or OS could be determined regarding the whole cohort; however, a significantly improved LC could be observed if the tumor was > 3 mm distant from the brainstem in patients presenting in a primary situation. CONCLUSION: Outcomes of proton and carbon ion treatment of skull base chordomas seem similar regarding tumor control, survival, and toxicity. Close proximity to the brainstem might be a negative prognostic factor, at least in patients presenting in a primary situation.
BACKGROUND: This study aimed to compare the results of irradiation with protons versus irradiation with carbon ions in a raster scan technique in patients with skull base chordomas and to identify risk factors that may compromise treatment results. METHODS: A total of 147 patients (85 men, 62 women) were irradiated with carbon ions (111 patients) or protons (36 patients) with a median dose of 66 Gy (RBE (Relative biological effectiveness); carbon ions) in 4 weeks or 74 Gy (RBE; protons) in 7 weeks at the Heidelberg Ion Beam Therapy Center (HIT) in Heidelberg, Germany. The median follow-up time was 49.3 months. All patients had gross residual disease at the beginning of RT. Compression of the brainstem was present in 38%, contact without compression in 18%, and no contact but less than 3 mm distance in 16%. Local control and overall survival were evaluated using the Kaplan-Meier Method based on scheduled treatment (protons vs. carbon ions) and compared via the log rank test. Subgroup analyses were performed to identify possible prognostic factors. RESULTS: During the follow-up, 41 patients (27.9%) developed a local recurrence. The median follow-up time was 49.3 months (95% CI: 40.8-53.8; reverse Kaplan-Meier median follow-up time 56.3 months, 95% CI: 51.9-60.7). No significant differences between protons and carbon ions were observed regarding LC, OS, or overall toxicity. The 1‑year, 3‑year, and 5‑year LC rates were 97%, 80%, and 61% (protons) and 96%, 80%, and 65% (carbon ions), respectively. The corresponding OS rates were 100%, 92%, and 92% (protons) and 99%, 91%, and 83% (carbon ions). No significant prognostic factors for LC or OS could be determined regarding the whole cohort; however, a significantly improved LC could be observed if the tumor was > 3 mm distant from the brainstem in patients presenting in a primary situation. CONCLUSION: Outcomes of proton and carbon ion treatment of skull base chordomas seem similar regarding tumor control, survival, and toxicity. Close proximity to the brainstem might be a negative prognostic factor, at least in patients presenting in a primary situation.
Authors: Brian P Walcott; Brian V Nahed; Ahmed Mohyeldin; Jean-Valery Coumans; Kristopher T Kahle; Manuel J Ferreira Journal: Lancet Oncol Date: 2012-02 Impact factor: 41.316
Authors: Brian J Jian; Orin G Bloch; Isaac Yang; Seunggu J Han; Derick Aranda; Tarik Tihan; Andrew T Parsa Journal: J Neurooncol Date: 2009-12-02 Impact factor: 4.130