title: Extracranial chordoma: Outcome in patients treated with function-preserving surgery followed by spot-scanning proton beam irradiation.
abstract: OBJECTIVE
  To evaluate the use of postoperative proton therapy (PT) in extracranial chordoma.
  
  
  METHODS
  Twenty-six patients were treated. Gross total resection was achieved in 18 patients. Nine patients had cervical, 2 had thoracic, 8 had lumbar, and 7 had sacro-coccygeal chordomas. Thirteen patients had implants. PT was administered after function-preserving surgery, using a gantry and spot scanning, without or with intensity modulation (IMPT; 6 patients), and/or photon-based radiotherapy (RT, 6 patients). Median total dose was 72 cobalt Gray equivalent (CGE; range, 59.4-74.4), with means of 70.5 and 73.2 CGE for patients with and without implants. Median follow-up time was 35 months (range, 13-73 months). Adverse events were scored using the Common Terminology Criteria for Adverse Events grading system (version 3.0).
  
  
  RESULTS
  At 3 years, actuarial overall survival (OS) and progression-free survival (PFS) rates were 84% and 77%, respectively. One patient each died of local failure (LF), distant failure (DF), suicide, and secondary tumor. We observed 5 LFs and 3 DFs; 3-year LF-free and DF-free survival rates were 86%. We observed four radiation-induced late adverse events (Grade 2 sensory neuropathy; Grade 3 subcutaneous necrosis, and osteonecrosis; and Grade 5 secondary cancer). In univariate analysis, implants were associated with LF (p = 0.034). Gross residual tumor above 30 mL was negatively associated with OS (p = 0.013) and PFS (p = 0.025).
  
  
  CONCLUSIONS
  Postoperative PT for extracranial chordomas delivered with spot scanning offers high local control rates. Toxicity was acceptable. Implants were significantly associated with LF. Residual tumor above 30 mL impacted negatively on OS and PFS.
authors.affiliation: Division of Radiation Medicine, Paul Scherrer Institute, Villigen, Switzerland. hanspeter.rutz@psi.ch
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Rutz
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
authors.forename: Shinji
authors.initials: S
authors.lastname: Sugahara
authors.forename: Beate
authors.initials: B
authors.lastname: Timmermann
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Lomax
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bolsi
authors.forename: Eros
authors.initials: E
authors.lastname: Pedroni
authors.forename: Adolf
authors.initials: A
authors.lastname: Coray
authors.forename: Martin
authors.initials: M
authors.lastname: Jermann
authors.forename: Gudrun
authors.initials: G
authors.lastname: Goitein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002817:Chordoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome