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Skull base chordomas: treatment outcome and prognostic factors in adult patients following conformal treatment with 3D planning and high dose fractionated combined proton and photon radiation therapy

Abstract

Purpose: To report treatment outcome and prognostic factors for local recurrence-free survival and overall survival in adult patients with skull base chordomas treated with 3D planning and high dose fractionated combined proton and photon radiation therapy. Methods and Materials: From 1975 through 1993, 132 adult patients with skull base chordomas were treated with fractionated combined proton and photon radiation therapy. Seventy five patients (57%) were male and 57 (43%) female. Age ranged from 19 to 80 years (median 45.5 years). All pathology was verified at MGH by a single pathologist. Ninety six had non-chondroid (NCC) and 36 chondroid chordomas (CC), respectively. Median prescribed dose was 68.7 CGE (CGE, Cobalt Gray-equivalent: proton Gy X RBE 1.1 + photon Gy), ranging from 36 to 79.2 CGE; 95% received {>=} 66.6 CGE. Between 70 and 100% of the dose was given with the 160 MeV proton beam at the Harvard Cyclotron. 3D CT-based treatment planning has been employed in all patients treated since 1980. Median follow-up was 46 months (range 2-158 months). Results: Treatment outcome was evaluated in terms of local recurrence-free survival (LRFS) and disease specific survival (DSS), as well as treatment-related morbidity. Local failure (LF), defined as progressive neurological deficit with  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ADULTS; BRAIN; CARCINOMAS; CHONDRITES; FORECASTING; FRACTIONATED IRRADIATION; GAMMA RADIATION; MULTIVARIATE ANALYSIS; PATHOLOGICAL CHANGES; PROTON BEAMS; RADIATION DOSES; RADIOTHERAPY; SKULL; SURVIVAL CURVES
OSTI ID:
20420655
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1891005060
Submitting Site:
INIS
Size:
page(s) 209
Announcement Date:

Citation Formats

Munzenrider, J E, Hug, E, McManus, P, Adams, J, Efird, J, and Liebsch, N J. Skull base chordomas: treatment outcome and prognostic factors in adult patients following conformal treatment with 3D planning and high dose fractionated combined proton and photon radiation therapy. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97799-7.
Munzenrider, J E, Hug, E, McManus, P, Adams, J, Efird, J, & Liebsch, N J. Skull base chordomas: treatment outcome and prognostic factors in adult patients following conformal treatment with 3D planning and high dose fractionated combined proton and photon radiation therapy. United States. doi:10.1016/0360-3016(95)97799-7.
Munzenrider, J E, Hug, E, McManus, P, Adams, J, Efird, J, and Liebsch, N J. 1995. "Skull base chordomas: treatment outcome and prognostic factors in adult patients following conformal treatment with 3D planning and high dose fractionated combined proton and photon radiation therapy." United States. doi:10.1016/0360-3016(95)97799-7. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97799-7.
@misc{etde_20420655,
title = {Skull base chordomas: treatment outcome and prognostic factors in adult patients following conformal treatment with 3D planning and high dose fractionated combined proton and photon radiation therapy}
author = {Munzenrider, J E, Hug, E, McManus, P, Adams, J, Efird, J, and Liebsch, N J}
abstractNote = {Purpose: To report treatment outcome and prognostic factors for local recurrence-free survival and overall survival in adult patients with skull base chordomas treated with 3D planning and high dose fractionated combined proton and photon radiation therapy. Methods and Materials: From 1975 through 1993, 132 adult patients with skull base chordomas were treated with fractionated combined proton and photon radiation therapy. Seventy five patients (57%) were male and 57 (43%) female. Age ranged from 19 to 80 years (median 45.5 years). All pathology was verified at MGH by a single pathologist. Ninety six had non-chondroid (NCC) and 36 chondroid chordomas (CC), respectively. Median prescribed dose was 68.7 CGE (CGE, Cobalt Gray-equivalent: proton Gy X RBE 1.1 + photon Gy), ranging from 36 to 79.2 CGE; 95% received {>=} 66.6 CGE. Between 70 and 100% of the dose was given with the 160 MeV proton beam at the Harvard Cyclotron. 3D CT-based treatment planning has been employed in all patients treated since 1980. Median follow-up was 46 months (range 2-158 months). Results: Treatment outcome was evaluated in terms of local recurrence-free survival (LRFS) and disease specific survival (DSS), as well as treatment-related morbidity. Local failure (LF), defined as progressive neurological deficit with definite increase in tumor volume on CT or MRI scan, occurred in 39 patients (29.5%). LF was more common among women than among men:(26(57)) (46%) vs (13(75)) (17%), respectively. Thirty three of the 39 LF were seen in non-chondroid chordoma patients, with 6 occurring in patients with the chondroid variant (34% of NCC and 17% of CC), respectively. Distant metastasis was documented in 8 patients. LRFS was 81 {+-} 5.8%, 59 {+-} 8.3%, and 43 {+-} 10.4%, and DSS was 94 {+-} 3.6%, 80 {+-} 6.7%, and 50 {+-} 10.7% at 36, 60, and 96 months, respectively, for the total group. LRFS and DSS were not significantly different for patients with NCC than those with CC (p > .05). Gender was significantly associated with treatment outcome only for NCC patients: LRFS was better for males than for females (85 {+-} 8.2%, 77{+-} 10.8% and 64 {+-} 14.9% vs 75 {+-} 10.5%, 40 {+-} 13%, and NA at 36, 60, and 96 months, respectively, p = .0003). DSS was also significantly better for male NCC patients than for females (95 {+-} 5.1%, 84 {+-} 9.4%, and 75{+-} 12.5%, vs. 89 {+-} 7.8%, 82 {+-} 9.4%, and 17 {+-} 15.1 % at 36, 60, and 96 months, respectively, p = .01). Treatment related morbidity included anatomical and functional abnormalities in the brain and brain stem, as well as deficits in visual, auditory, and endocrine function. Conclusions: Female sex is associated with a worse treatment outcome in patients with skull base NCC. LRFS and DSS by both univariate (Kaplan-Meier) and multivariate (Cox regression) analysis will be presented. The specific question of whether a relationship exists between treatment outcome, in terms of LF and/or DSS, and pre- or post-treatment endocrinopathy in either sex will be addressed. Treatment-related morbidity will also be described.}
doi = {10.1016/0360-3016(95)97799-7}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}