Clinical outcome of sacral chordoma with carbon ion radiotherapy compared with surgery.
OBJECTIVE
To evaluate the efficacy, post-treatment function, toxicity, and complications of carbon ion radiotherapy (RT) for sacral chordoma compared with surgery.


METHODS
The records of 17 primary sacral chordoma patients treated since 1990 with surgery (n = 10) or carbon ion RT (n = 7) were retrospectively analyzed for disease-specific survival, local recurrence-free survival, complications, and functional outcome. The applied carbon ion dose ranged from 54.0 Gray equivalent (GyE) to 73.6 GyE (median 70.4).


RESULTS
The mean age at treatment was 55 years for the surgery group and 65 years for the carbon ion RT group. The median duration of follow-up was 76 months for the surgery group and 49 months for the carbon ion RT group. The local recurrence-free survival rate at 5 years was 62.5% for the surgery and 100% for the carbon ion RT group, and the disease-specific survival rate at 5 years was 85.7% and 53.3%, respectively. Urinary-anorectal function worsened in 6 patients (60%) in the surgery group, but it was unchanged in all the patients who had undergone carbon ion RT. Postoperative wound complications requiring reoperation occurred in 3 patients (30%) after surgery and in 1 patient (14%) after carbon ion RT. The functional outcome evaluated using the Musculoskeletal Tumor Society scoring system revealed 55% in the surgery group and 75% in the carbon ion RT group. Of the six factors in this scoring system, the carbon ion RT group had significantly greater scores in emotional acceptance than did the surgery group.


CONCLUSIONS
Carbon ion RT results in a high local control rate and preservation of urinary-anorectal function compared with surgery.
Nishida
Yoshihiro
Y
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. ynishida@med.nagoya-u.ac.jp
Kamada
Tadashi
T
Imai
Reiko
R
Tsukushi
Satoshi
S
Yamada
Yoshihisa
Y
Sugiura
Hideshi
H
Shido
Yoji
Y
Wasa
Junji
J
Ishiguro
Naoki
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002244:Carbon / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002817:Chordoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003672:Defecation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012447:Sacrum; D013125:Spinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014554:Urination; D055815:Young Adult
D002244:Carbon