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

Thomas F. DeLaney, Norbert J. Liebsch, Francis X. Pedlow, Judith Adams, Susan Dean, Beow Y. Yeap, Patricia McManus, Andrew Rosenberg, G. Petur Nielsen, David C. Harmon, Ira J. Spiro, Kevin A. Raskin, Herman D. Suit, Sam S. Yoon, Francis J. Hornicek

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)732-739
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number3
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

Fingerprint

spine
Photons
Sarcoma
Protons
radiation therapy
Spine
Radiotherapy
cancer
dosage
protons
photons
spinal cord
Spinal Cord
nerves
viscera
tumors
Chordoma
Recurrence
Spinal Nerves
Phase II Clinical Trials

Keywords

  • Chordoma
  • Proton radiotherapy
  • Sarcoma
  • Spine

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

DeLaney, T. F., Liebsch, N. J., Pedlow, F. X., Adams, J., Dean, S., Yeap, B. Y., ... Hornicek, F. J. (2009). Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas. International Journal of Radiation Oncology Biology Physics, 74(3), 732-739. https://doi.org/10.1016/j.ijrobp.2008.08.058

Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas. / DeLaney, Thomas F.; Liebsch, Norbert J.; Pedlow, Francis X.; Adams, Judith; Dean, Susan; Yeap, Beow Y.; McManus, Patricia; Rosenberg, Andrew; Nielsen, G. Petur; Harmon, David C.; Spiro, Ira J.; Raskin, Kevin A.; Suit, Herman D.; Yoon, Sam S.; Hornicek, Francis J.

In: International Journal of Radiation Oncology Biology Physics, Vol. 74, No. 3, 01.07.2009, p. 732-739.

Research output: Contribution to journalArticle

DeLaney, TF, Liebsch, NJ, Pedlow, FX, Adams, J, Dean, S, Yeap, BY, McManus, P, Rosenberg, A, Nielsen, GP, Harmon, DC, Spiro, IJ, Raskin, KA, Suit, HD, Yoon, SS & Hornicek, FJ 2009, 'Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas', International Journal of Radiation Oncology Biology Physics, vol. 74, no. 3, pp. 732-739. https://doi.org/10.1016/j.ijrobp.2008.08.058
DeLaney, Thomas F. ; Liebsch, Norbert J. ; Pedlow, Francis X. ; Adams, Judith ; Dean, Susan ; Yeap, Beow Y. ; McManus, Patricia ; Rosenberg, Andrew ; Nielsen, G. Petur ; Harmon, David C. ; Spiro, Ira J. ; Raskin, Kevin A. ; Suit, Herman D. ; Yoon, Sam S. ; Hornicek, Francis J. / Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 74, No. 3. pp. 732-739.
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AU - Pedlow, Francis X.

AU - Adams, Judith

AU - Dean, Susan

AU - Yeap, Beow Y.

AU - McManus, Patricia

AU - Rosenberg, Andrew

AU - Nielsen, G. Petur

AU - Harmon, David C.

AU - Spiro, Ira J.

AU - Raskin, Kevin A.

AU - Suit, Herman D.

AU - Yoon, Sam S.

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N2 - 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.

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KW - Chordoma

KW - Proton radiotherapy

KW - Sarcoma

KW - Spine

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