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Carbon ion beam treatment in patients with primary and recurrent sacrococcygeal chordoma

Kohlenstoffionenbestrahlung von Patienten mit primären und rezidivierten sakralen Chordomen

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Abstract

Purpose

The purpose of this work was to evaluate the results of high-dose radiation treatment using carbon ion therapy, alone or combined with intensity-modulated radiation treatment (IMRT), in patients with sacral chordoma.

Materials and methods

Between 2009 and 2012, 56 patients with sacral chordoma were treated in our center. The tumor was located above S3 in 33 patients and in S3 or below in 23 patients. In all, 41 patients received radiation therapy for the primary tumor, while 15 patients were treated for the recurrent tumor. Toxicity was measured using NCI CTCAE v.4.03. Local control (LC) and overall survival (OS) were evaluated with the Kaplan–Meier method.

Results

A total of 23 patients were irradiated with carbon ions in combination with photon IMRT, while 33 received carbon ion therapy only. Forty-three patients had a macroscopic tumor at treatment start with a median tumor size (GTV) of 244 ml (range 5–1188 ml). The median total dose was 66 Gy (range 60–74 Gy; RBE). After a median follow-up time of 25 months, the 2- and 3-year local control probability was 76 % and 53 %, respectively. The overall survival rate was 100 %. Treatment for primary tumor and male patients resulted in significant better local control. No higher toxicity occurred within the follow-up time.

Conclusion

High-dose photon/carbon ion beam radiation therapy is safe and, especially for primary sacral chordomas, highly effective. A randomized trial is required to evaluate the role of primary definitive hypofractionated particle therapy compared with surgery with or without adjuvant radiotherapy.

Zusammenfassung

Zielsetzung

Evaluierung der Ergebnisse nach hochdosierter Kohlenstoffionentherapie, allein oder in Kombination mit einer intensitätsmodulierten Photonenbestrahlung (IMRT), bei Patienten mit einem sakralen Chordom.

Material und Methoden

Zwischen 2009 und 2012 wurden 56 Patienten mit sakralen Chordomen in unserem Zentrum behandelt. Der Tumor war bei 33 Patienten oberhalb von S3 und bei 23 Patienten auf Höhe von S3 oder unterhalb davon lokalisiert. Insgesamt wurden 41 Patienten innerhalb der Primärtherapie und 15 Patienten innerhalb einer Rezidivtherapie behandelt. Die Erfassung der Toxizität erfolgte gemäß NCI CTCAE v.4.03. Lokale Kontrolle (LC) und Gesamtüberleben (OS) wurden mithilfe der Kaplan-Meier-Methode bestimmt.

Ergebnisse

Insgesamt 23 Patienten wurden mit Kohlenstoffionen in Kombination mit Photonen-IMRT bestrahlt, während 33 eine alleinige Kohlenstoffionentherapie erhielten. Zu Beginn der Therapie hatten 43 Patienten einen makroskopischen Tumor mit einer medianen Tumorgröße (GTV) von 244 ml (5–1188 ml). Die applizierte mediane Gesamtdosis betrug 66 Gy (60–74 Gy; RBE). Nach einer medianen Nachbeobachtungszeit von 25 Monaten lag die 2- und 3-Jahres-LC bei 76% bzw. 53%. Die OS-Rate betrug 100%. Die Behandlung innerhalb der Primärtherapie und männlichen Patienten zeigten eine signifikant bessere LC. Die Behandlung führte zu keiner höhergradigen Toxizität.

Schlussfolgherung

Eine hochdosierte Strahlentherapie mit Photonen bzw. Kohlenstoffionen ist sicher durchführbar und ist, vor allem innerhalb der Primärtherapie eines sakralen Chordoms, sehr effektiv. Eine randomisierte Studie ist erforderlich, um die Rolle der primären definitiven hypofraktionierten Partikeltherapie im Vergleich zu einer operativen Therapie mit oder ohne adjuvante Strahlentherapie zu evaluieren.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Matthias Uhl M.D., Thomas Welzel M.D., Alexandra Jensen M.D., Oliver Jäkel Ph.D., Klaus Herfarth M.D. & Jürgen Debus M.D., Ph.D.

  2. Heidelberg Ion Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany

    Matthias Uhl M.D., Alexandra Jensen M.D., Malte Ellerbrock Ph.D., Thomas Haberer Ph.D., Oliver Jäkel Ph.D., Klaus Herfarth M.D. & Jürgen Debus M.D., Ph.D.

  3. German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Oliver Jäkel Ph.D. & Jürgen Debus M.D., Ph.D.

  4. Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany

    Oliver Jäkel Ph.D. & Jürgen Debus M.D., Ph.D.

  5. Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Germany

    Jürgen Debus M.D., Ph.D.

Authors
  1. Matthias Uhl M.D.
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  2. Thomas Welzel M.D.
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  3. Alexandra Jensen M.D.
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  4. Malte Ellerbrock Ph.D.
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  5. Thomas Haberer Ph.D.
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  6. Oliver Jäkel Ph.D.
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  7. Klaus Herfarth M.D.
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  8. Jürgen Debus M.D., Ph.D.
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Corresponding author

Correspondence to Matthias Uhl M.D..

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Conflict of interest

J. Debus states that he is CEO of Heidelberg Ion Therapy Center (HIT). M. Uhl, T. Welzel, A. Jensen, M. Ellerbrock, T. Haberer, O. Jäkel, and K. Herfarth state that there are no conflicts of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study

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Uhl, M., Welzel, T., Jensen, A. et al. Carbon ion beam treatment in patients with primary and recurrent sacrococcygeal chordoma. Strahlenther Onkol 191, 597–603 (2015). https://doi.org/10.1007/s00066-015-0825-3

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  • DOI: https://doi.org/10.1007/s00066-015-0825-3

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