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Definitive high-dose, proton-based radiation for unresected mobile spine and sacral chordomas
Walter Banfield1, Myrsini Ioakeim-Ioannidou2, Saveli Goldberg2
1University of Virginia School of Medicine, Charlottesville, United States.
Summary
High-dose proton radiotherapy offers effective treatment for unresected spinal and sacral chordomas, demonstrating strong local control and survival rates. This approach is a viable alternative for patients unsuitable for surgery, with higher doses potentially improving outcomes.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Spine and sacral chordoma treatment typically involves surgery and radiation.
- Definitive radiation therapy is an alternative for unresectable tumors or when surgery poses neurological risks.
Purpose of the Study:
- To report outcomes of high-dose, proton-based definitive radiotherapy for unresected spinal and sacral chordomas.
- Evaluate the efficacy and safety of proton therapy as a primary treatment modality.
Main Methods:
- Retrospective review of 67 patients with newly diagnosed, unresected spinal chordomas.
- Treatment involved high-dose definitive proton-based radiotherapy (median 77.4 Gy RBE) between 1975-2019.
- Analysis included overall survival, disease-free survival, local control, and distant control with median follow-up of 56.2 months.
Main Results:
- At 5 and 8 years, overall survival was 83.5% and 65.9%, respectively.
- Disease-free survival was 64% at 5 years and 44.1% at 8 years.
- Local control rates were 81.8% (5 years) and 63.6% (8 years); the most common late side effect was insufficiency fracture.
Conclusions:
- High-dose definitive radiotherapy supports treatment for medically inoperable or unresected chordomas.
- A trend towards improved disease-free survival was observed with doses exceeding 78 Gy (RBE).
