Proton or Carbon Ion Therapy for Skull Base Chordoma: Rationale and First Analysis of a Mono-Institutional Experience
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Participant Characteristics
2.2. Patient Simulation and Immobilization
2.3. Volume Definition
2.4. Treatment Planning
2.5. Dose Prescription
2.6. Follow-Up
2.7. Statistical Analysis
3. Results
4. Discussion
- (i.)
- Dose escalation with an inhomogeneous boost to the portion of GTV not abutting the brainstem or optic chiasm, and,
- (ii.)
- Escalation of the dose constraint to the brainstem without increased risk of brainstem toxicity. This could be achieved with LET (linear energy transfer) painting.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Sex: | Total Patients: 44 |
---|---|
Male | 24/55% |
Female | 20/45% |
AGE: | Years |
Average (range) | 47 (19–87) |
KPS: Median (range) | 90% (60–100) |
TUMOR SITE | |
Upper clivus | 30/68% |
Lower clivus | 14/32% |
SURGERY: | |
Subtotal tumor resection | 25/57% |
Gross total resection | 9/21% |
Biopsy | 5/12% |
Decompression | 4/9% |
TUMOR-RELATED SYMPTOMS: | 41/93% |
Cranial nerve deficit: | 27/61% |
- High: III, IV, VI (diplopia, ptosis) | 22/50% |
- Middle: V, VII (trigeminal neuralgia, facial paralysis/weakness) | 3/7% |
- Low: IX, X, XII (dysphagia and tongue lateral deviation) | 8/18% |
GROSS TUMOR VOLUME median (range) cm3 | 28.1 (1.4–218.9) |
Brainstem or optic pathway compression/abutment | |
- yes | 25/57% |
- no | 19/43% |
Vascular involvement (A. carotis/A. basilaris) | |
- yes | 2/5% |
- no | 42/95% |
Intradural invasion | |
- yes | 3/7% |
- no | 41/93% |
Local Failures | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
Tumor location | lower clivus | lower clivus | lower clivus | upper clivus | upper clivus |
Tumor volume (ccm) | 76 | 49 | 101 | 242 | 80 |
Vascular involvement | NO | NO | NO | NO | NO |
Intradural invasion | NO | YES | NO | NO | NO |
Brainstem/optic compression/abutment | YES | YES | NO | NO | YES |
Type of particles | protons | protons | protons | protons | carbon |
Radiation prescription dose (Gy RBE) | 76 | 75.6 | 78.2 | 78 | 66 |
Dose to CTV1 95% | 63.39 | 61.44 | 68.69 | 69.26 | 59.93 |
Dose to CTV1 98% | 60.27 | 59.67 | 64.95 | 61.76 | 57.25 |
Dose to CTV2 95% | 68.78 | 73.46 | 70.96 | 74.24 | 64.88 |
Dose to CTV2 98% | 65.01 | 70.54 | 67.58 | 71.16 | 59.03 |
Time to recurrence (months) | 10 | 34 | 27 | 37 | 1 |
Surgical resection | biopsy | decompression | subtotal | subtotal | biopsy |
Radiation-induced brain tissue changes | NO | NO | NO | YES | NO |
Alive at time of analysis: yes/no | NO | YES | YES | YES | NO |
Follow up duration (months) | 26 | 55 | 39 | 43 | 1 |
Tumor Volume | Local Recurrence | |
---|---|---|
no | yes | |
<50 cm3 | 35 (89.7%) | 1 (20.0%) |
>50 cm3 | 4 (10.3%) | 4 (80.0%) |
RISK OF LOCAL RECURRENCE | ||
50 cm3 | 11.8% | |
81.1 cm3 | 50% |
Patient | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
GTV pre-OP volume (cc) | 48.64 | 79.63 | 8.31 | 24.64 | 80.46 |
Surgery | biopsy | debulking | debulking | debulking | biopsy |
Site | lower clivus | lower clivus | upperclivus | lowerclivus | upper and lower clivus |
CTV1 95% (Gy) | 55.65 | 48.19 | 48.2 | 59.83 | 59.93 |
CTV1 98% (Gy) | 51.84 | 45.65 | 46.3 | 58.08 | 57.25 |
CTV2 95% (Gy) | 63.09 | 64.10 | 62.61 | 65.30 | 64.88 |
CTV2 95% (Gy) | 59.65 | 62.41 | 58.05 | 64.39 | 59.03 |
Abutment or compression of optic structures and/or brainstem | YES | YES | YES | NO | YES |
Toxicity | Mucositis G1, Fatigue G1 | Tinnitus G1, Alopecia G2 | Headache G2, Vertigo G2 | Dysphagia G2, Mucositis G2 | Nausea G2, Appetite loss G2 |
Radiation-induced brain tissue changes or brain necrosis | NO | NO | NO | NO | NO |
Local control | YES | YES | YES | YES | NO |
Follow up (months) | 13 | 33 | 11 | 11 | 1 |
Pros | Cons | |
---|---|---|
PBT | Excellent result confirmed by multicentric series with large number of patients and long follow up | Larger spot size and less steep lateral penumbra possibly resulting in more undercoverage of target volumes in unfavorable cases |
Well-known toxicity profile and well-validated dose constraints | Significant dependency on residual tumor volume | |
CIRT | Smaller spot size and sharper penumbra potentially resulting in better target volume coverage also in unfavorable cases | More limited clinical experience available (fewer patients, shorter follow up) |
Potentially less dependent on residual tumor volume | Less well-established dose constraints for OARs |
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Tubin, S.; Fossati, P.; Mock, U.; Lütgendorf-Caucig, C.; Flechl, B.; Pelak, M.; Georg, P.; Fussl, C.; Carlino, A.; Stock, M.; et al. Proton or Carbon Ion Therapy for Skull Base Chordoma: Rationale and First Analysis of a Mono-Institutional Experience. Cancers 2023, 15, 2093. https://doi.org/10.3390/cancers15072093
Tubin S, Fossati P, Mock U, Lütgendorf-Caucig C, Flechl B, Pelak M, Georg P, Fussl C, Carlino A, Stock M, et al. Proton or Carbon Ion Therapy for Skull Base Chordoma: Rationale and First Analysis of a Mono-Institutional Experience. Cancers. 2023; 15(7):2093. https://doi.org/10.3390/cancers15072093
Chicago/Turabian StyleTubin, Slavisa, Piero Fossati, Ulrike Mock, Carola Lütgendorf-Caucig, Birgit Flechl, Maciej Pelak, Petra Georg, Christoph Fussl, Antonio Carlino, Markus Stock, and et al. 2023. "Proton or Carbon Ion Therapy for Skull Base Chordoma: Rationale and First Analysis of a Mono-Institutional Experience" Cancers 15, no. 7: 2093. https://doi.org/10.3390/cancers15072093