Postoperative proton therapy in patients with chordoma and chondrosarcoma can significantly reduce tumor recurrence rate
Release date: 2017-03-13
Chordoma and chondrosarcoma are rare, slow-growing tumors. On the one hand, they have strong infiltration, and on the other hand, they are close to important tissues of the body, so it is difficult to completely remove the tumor tissue and achieve negative margins. Therefore, it is often necessary to perform adjuvant treatment after surgery.
However, because such tumors are relatively resistant to radiation therapy, require high doses, and are close to vital organs such as the spinal cord and nerve roots, which increases the risk of radiation toxicity. Generally speaking, the upper limit of the spinal cord's tolerance to radiation is 50Gray, above which the risk of nerve palsy is caused. However, studies have shown that using photon radiation at doses below 60 Gray results in a tumor recurrence rate of 50% to 100%, with a five-year disease progression rate of less than 25%. In other words, the 60Gray photon dose is far from satisfactory disease control rate, but it may cause significant toxic effects on nerves. This is undoubtedly a contradiction for radiotherapy experts.
Proton therapy solves this problem well: Thanks to the physical properties of its Bragg peak, proton therapy can precisely target the target area for high-dose irradiation while at the same time avoiding radiation to important organ structures in adjacent tumors. . Both are the best, and thus become an important treatment for chordoma and chondrosarcoma.
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The following is a study of the Proton Therapy Center at the MD Anderson Cancer Center to assess local control, recurrence, and overall survival in patients with myeloma and spinal chondrosarcoma who underwent proton therapy. The effect of postoperative proton therapy on prognostic factors such as local control rate was also assessed .
METHODS: This study selected 19 patients who underwent postoperative proton therapy in a single institution between 2006 and 2012, 13 of whom were chordoma patients and 6 were chondrosarcoma patients. From the point of view of the tumor, 3 cases of cervical vertebrae, 1 case of thoracic vertebrae, 2 cases of lumbar vertebrae and 13 cases of atlas. Among them, 8 patients who underwent proton therapy after the first surgery were classified as patients with "early adjuvant" treatment, and 11 patients who underwent proton therapy after local recurrence were classified as "rescue" treatment. The median therapeutic dose was 70 Gy (range: 56-78 Gy).
RESULTS: In the entire trial group, the 2-year local control rate, recurrence-free rate, and overall survival rate were divided into 58%, 51.9%, and 93.3%. The recurrence rate of the early-assisted proton therapy group was significantly lower than that of the "rescuer" treatment group, and the 2-year local control rate, 5-year local control rate, and 2-year recurrence survival rate were significantly improved.
Conclusion: The treatment of spinal chordoma and chondrosarcoma is challenging because both tumors have a tendency to prone to local recurrence. Postoperative radiotherapy can reduce the local recurrence rate, but the first radiotherapy distance from the surgery and whether there are residual lesions during radiotherapy will affect the prognosis. In patients who received the first adjuvant radiotherapy early in the postoperative period, the disease control rate was significantly higher than that of patients who underwent "rescuing" radiotherapy after recurrence. Not only this research, but also other studies such as the Curie Institute in France, the Paul Scherrer Institute in Switzerland , and the Massachusetts Institute of General Research Institute have confirmed this view. Therefore, we recommend that patients consult postoperative radiotherapy as soon as possible after surgery to prevent tumor recurrence or progression. In addition, we need to consider strategies to further enhance the local control rate, including the upgrade of radiotherapy doses and the use of more compliant radiotherapy techniques, such as proton styling. Studies have shown that proton therapy can better protect important organs around the tumor and better control the tumor than other conventional radiotherapy methods.
Source: MD Anderson Proton Treatment Center Referral Office
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