Radiat Oncol J.  2018 Sep;36(3):182-191. 10.3857/roj.2018.00164.

Clinical outcome of proton therapy for patients with chordomas

Affiliations
  • 1Proton Therapy Center, National Cancer Center Research Institute and Hospital, National Cancer Center, Goyang, Korea. kwancho@ncc.re.kr
  • 2Neuro-Oncology Clinic, National Cancer Center Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 3Department of Radiology, National Cancer Center Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 4Department of Pathology, National Cancer Center Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 5Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea.

Abstract

PURPOSE
To investigate the clinical outcome of proton therapy (PT) in patients with chordoma.
MATERIALS AND METHODS
Fifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and diseasespecific survival (DSS) rates were calculated by the Kaplan-Meier method.
RESULTS
With the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4.
CONCLUSION
PT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.

Keyword

Chordoma; Proton therapy; Treatment outcome; Complications

MeSH Terms

Chordoma*
Cobalt
Disease-Free Survival
Follow-Up Studies
Humans
Korea
Methods
Proton Therapy*
Protons*
Retrospective Studies
Treatment Outcome
Cobalt
Protons
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