Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas

Journal Article · Wed Jul 01 00:00:00 EDT 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.08.058· OSTI ID:21276857

Liebsch, Norbert J ^[1]; Pedlow, Francis X ^[2]; Adams, Judith; Dean, Susan ^[1]; Yeap, Beow Y ^[3]; McManus, Patricia ^[1]; Rosenberg, Andrew E; Nielsen, G Petur ^[4]; Harmon, David C ^[5]; Spiro, Ira J ^[1]; Raskin, Kevin A ^[2]; Suit, Herman D ^[1]; Yoon, Sam S ^[6]; Hornicek, Francis J ^[2]

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1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
2. Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
3. Department of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
4. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
5. Department of Medicine, Division of Hematology Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
6. Department of Surgery (Section of Surgical Oncology), Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)

Purpose: Radiotherapy (XRT) for spine sarcomas is constrained by spinal cord, nerve, and viscera tolerance. Negative surgical margins are uncommon; hence, doses of {>=}66 Gy are recommended. A Phase II clinical trial evaluated high-dose photon/proton XRT for spine sarcomas. Methods and Materials: Eligible patients had nonmetastatic, thoracic, lumbar, and/or sacral spine/paraspinal sarcomas. Treatment included pre- and/or postoperative photon/proton XRT with or without radical resection; patients with osteosarcoma and Ewing's sarcoma received chemotherapy. Shrinking fields delivered 50.4 cobalt Gray equivalent (Gy RBE) to subclinical disease, 70.2 Gy RBE to microscopic disease in the tumor bed, and 77.4 Gy RBE to gross disease at 1.8 Gy RBE qd. Doses were reduced for radiosensitive histologies, concurrent chemoradiation, or when diabetes or autoimmune disease present. Spinal cord dose was limited to 63/54 Gy RBE to surface/center. Intraoperative boost doses of 7.5 to 10 Gy could be given by dural plaque. Results: A total of 50 patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n = 25) or subtotal (n = 12) resection or biopsy (n = 13). With 48 month median follow-up, 5-year actuarial local control, recurrence-free survival, and overall survival are: 78%, 63%, and 87% respectively. Two of 36 (5.6%) patients treated for primary versus 7/14 (50%) for recurrent tumor developed local recurrence (p < 0.001). Five patients developed late radiation-associated complications; no myelopathy developed but three sacral neuropathies appeared after 77.12 to 77.4 Gy RBE. Conclusions: Local control with this treatment is high in patients radiated at the time of primary presentation. Spinal cord dose constraints appear to be safe. Sacral nerves receiving 77.12-77.4 Gy RBE are at risk for late toxicity.

• OSTI ID: 21276857
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 74, Issue 3; Other Information: DOI: 10.1016/j.ijrobp.2008.08.058; PII: S0360-3016(08)03504-9; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BIOPSY
CHEMOTHERAPY
CLINICAL TRIALS
COBALT
HAZARDS
HISTOLOGY
NERVES
OSTEOSARCOMAS
PATIENTS
PHOTONS
RADIATION DOSES
RADIOTHERAPY
SPINAL CORD
SURGERY
TOXICITY
VERTEBRAE