Top

Published in:

Open Access 01-12-2018 | Research

Treatment outcomes of proton or carbon ion therapy for skull base chordoma: a retrospective study

Authors: Masaru Takagi, Yusuke Demizu, Fumiko Nagano, Kazuki Terashima, Osamu Fujii, Dongcun Jin, Masayuki Mima, Yasue Niwa, Kuniaki Katsui, Masaki Suga, Tomohiro Yamashita, Takashi Akagi, Koh-ichi Sakata, Nobukazu Fuwa, Tomoaki Okimoto

Published in: Radiation Oncology | Issue 1/2018

Abstract

Background

The usefulness of particle therapy for skull base chordoma has not been established. The aim of this retrospective study was to analyse the treatment outcomes of proton therapy (PT) and carbon ion therapy (CIT) in patients with skull base chordoma at a single institution.

Methods

All patients who underwent PT or CIT with curative intent between 2003 and 2014 at Hyogo Ion Beam Medical Center were included in this study. Twenty-four patients were enrolled. Eleven (46%) received PT and 13 (54%) received CIT. Overall survival (OS), progression-free survival (PFS) and local control (LC) were calculated using the Kaplan–Meier method. Late toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0.

Results

The median follow-up was 71.5 months (range, 14–175 months). The five-year LC, PFS and OS rates were 85, 81, and 86%, respectively. The LC (P = 0.048), PFS (P = 0.028) and OS (P = 0.012) were significantly improved in patients who had undergone surgery before particle therapy. No significant differences were observed in the LC rate and the incidence of grade 2 or higher late toxicities between patients who received PT and CIT.

Conclusions

Both PT and CIT appear to be effective and safe treatments and show potential to become the standard treatments for skull base chordoma. To increase the local control, surgery before particle therapy is preferable.

Mayer IA, Raghavan D, Brecher ML, et al. Textbook of uncommon cancer: John Wiley & Sons, 2006; 614–625.

Fletcher CD, Unni KK Mertens F. Pathology and genetics of tumours of soft tissue and bone, vol. 4. Lyon: Iarc; 2002. 316–317.

Chugh R, Tawbi H, Lucas DR, et al. Chordoma: the nonsarcoma primary bone tumor. Oncologist. 2007;12:1344–50. https://doi.org/10.1634/theoncologist.12-11-1344.CrossRefPubMed

Tzortzidis F, Elahi F, Wright D, et al. Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chordomas. Neurosurgery 2006;59:230–237; discussion −7. https://doi.org/10.1227/01.neu.0000223441.51012.9d.CrossRef

Colli BO, Al-Mefty O. Chordomas of the skull base: follow-up review and prognostic factors. Neurosurg Focus. 2001;10:E1. https://doi.org/10.3171/foc.2001.10.3.2.CrossRefPubMed

Debus J, Schulz-Ertner D, Schad L, et al. Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys. 2000;47:591–6.CrossRef

Zorlu F, Gurkaynak M, Yildiz F, et al. Conventional external radiotherapy in the management of clivus chordomas with overt residual disease. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2000;21:203–7.CrossRef

Habrand IL, Austin-Seymour M, Birnbaum S, et al. Neurovisual outcome following proton radiation therapy. Int J Radiat Oncol Biol Phys. 1989;16:1601–6.CrossRef

Catton C, O'Sullivan B, Bell R, et al. Chordoma: long-term follow-up after radical photon irradiation. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 1996;41:67–72.CrossRef

10.

Austin-Seymour M, Munzenrider J, Goitein M, et al. Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull. J Neurosurg. 1989;70:13–7. https://doi.org/10.3171/jns.1989.70.1.0013.CrossRefPubMed

11.

Hug EB, Loredo LN, Slater JD, et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg. 1999;91:432–9. https://doi.org/10.3171/jns.1999.91.3.0432.CrossRefPubMed

12.

Ares C, Hug EB, Lomax AJ, et al. Effectiveness and safety of spot scanning proton radiation therapy for chordomas and chondrosarcomas of the skull base: first long-term report. Int J Radiat Oncol Biol Phys. 2009;75:1111–8. https://doi.org/10.1016/j.ijrobp.2008.12.055.CrossRefPubMed

13.

Hayashi Y, Mizumoto M, Akutsu H, et al. Hyperfractionated high-dose proton beam radiotherapy for clival chordomas after surgical removal. Br J Radiol. 2016;89:20151051. https://doi.org/10.1259/bjr.20151051.CrossRefPubMedPubMedCentral

14.

Schulz-Ertner D, Karger CP, Feuerhake A, et al. Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas. Int J Radiat Oncol Biol Phys. 2007;68:449–57. https://doi.org/10.1016/j.ijrobp.2006.12.059.CrossRefPubMed

15.

Mizoe JE, Hasegawa A, Takagi R, et al. Carbon ion radiotherapy for skull base chordoma. Skull base : official journal of North American Skull Base Society ... [et al.] 2009;19:219–224. https://doi.org/10.1055/s-0028-1114295.CrossRef

16.

Uhl M, Mattke M, Welzel T, et al. Highly effective treatment of skull base chordoma with carbon ion irradiation using a raster scan technique in 155 patients: first long-term results. Cancer. 2014;120:3410–7. https://doi.org/10.1002/cncr.28877.CrossRefPubMed

17.

Fagundes MA, Hug EB, Liebsch NJ, et al. Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse. Int J Radiat Oncol Biol Phys. 1995;33:579–84. https://doi.org/10.1016/0360-3016(95)02014-3.CrossRefPubMed

18.

Noel G, Feuvret L, Ferrand R, et al. Radiotherapeutic factors in the management of cervical-basal chordomas and chondrosarcomas. Neurosurgery. 2004;55:1252–60 discussion 60-2.CrossRef

19.

Bugoci DM, Girvigian MR, Chen JC, et al. Photon-based fractionated stereotactic radiotherapy for postoperative treatment of skull base chordomas. Am J Clin Oncol. 2013;36:404–10. https://doi.org/10.1097/COC.0b013e318248dc6f.CrossRefPubMed

20.

Kagawa K, Murakami M, Hishikawa Y, et al. Preclinical biological assessment of proton and carbon ion beams at Hyogo ion beam medical center. Int J Radiat Oncol Biol Phys. 2002;54:928–38.CrossRef

21.

Fowler JF. 21 years of biologically effective dose. Br J Radiol. 2010;83:554–68. https://doi.org/10.1259/bjr/31372149.CrossRefPubMedPubMedCentral

22.

Health UDo Services H. National cancer institute. Common terminology criteria for adverse events (ctcae) version 4.0, 2013.

23.

Douglas BG, Fowler JF. The effect of multiple small doses of x rays on skin reactions in the mouse and a basic interpretation. 1976. Radiat Res. 2012;178:AV125–38.CrossRef

24.

Boriani S, Bandiera S, Biagini R, et al. Chordoma of the mobile spine: fifty years of experience. Spine. 2006;31:493–503. https://doi.org/10.1097/01.brs.0000200038.30869.27.CrossRefPubMed

25.

Bone sarcomas: Esmo clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 Suppl 3:iii113–iii123. https://doi.org/10.1093/annonc/mdu256.

26.

Stacchiotti S, Sommer J. Building a global consensus approach to chordoma: a position paper from the medical and patient community. The Lancet Oncology. 2015;16:e71–83. https://doi.org/10.1016/s1470-2045(14)71190-8.CrossRefPubMed

27.

Sahgal A, Chan MW, Atenafu EG, et al. Image-guided, intensity-modulated radiation therapy (ig-imrt) for skull base chordoma and chondrosarcoma: preliminary outcomes. Neuro-Oncology. 2015;17:889–94. https://doi.org/10.1093/neuonc/nou347.CrossRefPubMed

28.

Demizu Y, Mizumoto M, Onoe T, et al. Proton beam therapy for bone sarcomas of the skull base and spine: a retrospective nationwide multicenter study in Japan. Cancer Sci. 2017;108:972–7. https://doi.org/10.1111/cas.13192.CrossRefPubMedPubMedCentral

29.

Koga T, Shin M, Saito N. Treatment with high marginal dose is mandatory to achieve long-term control of skull base chordomas and chondrosarcomas by means of stereotactic radiosurgery. J Neuro-Oncol. 2010;98:233–8. https://doi.org/10.1007/s11060-010-0184-y.CrossRef

30.

Noel G, Feuvret L, Calugaru V, et al. Chordomas of the base of the skull and upper cervical spine. One hundred patients irradiated by a 3d conformal technique combining photon and proton beams. Acta Oncol (Stockholm, Sweden) 2005;44:700–708. https://doi.org/10.1080/02841860500326257.CrossRef

31.

Suit H, DeLaney T, Goldberg S, et al. Proton vs carbon ion beams in the definitive radiation treatment of cancer patients. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2010;95:3–22. https://doi.org/10.1016/j.radonc.2010.01.015.CrossRef

Title: Treatment outcomes of proton or carbon ion therapy for skull base chordoma: a retrospective study
Authors: Masaru Takagi
Yusuke Demizu
Fumiko Nagano
Kazuki Terashima
Osamu Fujii
Dongcun Jin
Masayuki Mima
Yasue Niwa
Kuniaki Katsui
Masaki Suga
Tomohiro Yamashita
Takashi Akagi
Koh-ichi Sakata
Nobukazu Fuwa
Tomoaki Okimoto
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-018-1173-0

At a glance: The STEP trials

Springer Medicine

Treatment outcomes of proton or carbon ion therapy for skull base chordoma: a retrospective study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Evaluation of particle radiotherapy for the re-irradiation of recurrent intracranial meningioma

Retraction Note: SNPs in genes implicated in radiation response are associated with radiotoxicity and evoke roles as predictive and prognostic biomarkers

Radioligand therapy of metastatic castration-resistant prostate cancer: current approaches

Significance of intra-fractional motion for pancreatic patients treated with charged particles

Changes in cardiac volume determined with repeated enhanced 4DCT during chemoradiotherapy for esophageal cancer

An esophagus-sparing technique to limit radiation esophagitis in locally advanced non-small cell lung cancer treated by simultaneous integrated boost intensity-modulated radiotherapy and concurrent chemotherapy