Skip to main content

Advertisement

Log in

Clinical results of carbon-ion radiotherapy with separation surgery for primary spine/paraspinal sarcomas

International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the clinical outcome of combination of carbon-ion radiotherapy with separation surgery (CIRT-SS) in patients with primary spinal/paraspinal sarcoma (PSPS) and epidural spinal cord compression (ESCC).

Methods

CIRT-SS was performed in 11 consecutive patients. Patients treated in the primary and salvage settings were categorized into Group A (n = 8) and Group B (n  = 3), respectively. Clinical results and imaging findings were collected, with a particular focus on ESCC grade, treatment-associated adverse events (AEs), and the locoregional control (LRC) rate and overall survival (OS).

Results

The median follow-up period from the start of CIRT-SS was 25 months (7–57 months). ESCC was improved by SS in all cases. No patients exhibited radiation-induced myelopathy (RIM), but three developed Grade 3 vertebral compression fracture (VCF) during follow-up. Locoregional recurrences were observed in four patients [Group A: 1 (12.5%), Group B: 3 (100%)]. Over the entire follow-up period, three patients developed distant metastases and two patients died. The 2-year LRC rate and OS were 70% and 80%, respectively.

Conclusion

CIRT-SS in the primary setting achieved acceptable LRC and OS without RIM in patients with PSPS and with ESCC. VCF was the most frequent AE associated with CIRT-SS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Catton C, O'Sullivan B, Bell R et al (1996) Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 41:67–72

    Article  CAS  Google Scholar 

  2. Matsunobu A, Imai R, Kamada T et al (2012) Impact of carbon ion radiotherapy for unresectable osteosarcoma of the trunk. Cancer 118:4555–4563

    Article  Google Scholar 

  3. Matsumoto K, Imai R, Kamada T et al (2013) Impact of carbon ion radiotherapy for primary spinal sarcoma. Cancer 119:3496–3503

    Article  CAS  Google Scholar 

  4. Grimm J, Sahgal A, Soltys SG et al (2016) Estimated risk level of unified stereotactic body radiation therapy dose tolerance limits for spinal cord. Semin Radiat Oncol 26:165–171

    Article  Google Scholar 

  5. Al-Omair A, Masucci L, Masson-Cote L et al (2013) Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro-Oncology 15:1413–1419

    Article  Google Scholar 

  6. Husain ZA, Sahgal A, Chang EL et al (2017) Modern approaches to the management of metastatic epidural spinal cord compression. CNS Oncol 6:231–241

    Article  CAS  Google Scholar 

  7. Lockney DT, Shub T, Hopkins B et al (2017) Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment. Neurosurg Focus 42:E4

    Article  Google Scholar 

  8. Moulding HD, Elder JB, Lis E et al (2010) Local disease control after decompressive surgery and adjuvant high-dose single-fraction radiosurgery for spine metastases. J Neurosurg Spine 13:87–93

    Article  Google Scholar 

  9. Laufer I, Iorgulescu JB, Chapman T et al (2013) Local disease control for spinal metastases following "separation surgery" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine 18:207–214

    Article  Google Scholar 

  10. Pennicooke B, Laufer I, Sahgal A et al (2016) Safety and Local control of radiation therapy for chordoma of the spine and sacrum: a systematic review. Spine 41:S186–192

    Article  Google Scholar 

  11. Matsumoto Y, Shinoto M, Endo M et al (2017) Evaluation of risk factors for vertebral compression fracture after carbon-ion radiotherapy for primary spinal and paraspinal sarcoma. BioMed Res Int 2017:9467402

    PubMed  PubMed Central  Google Scholar 

  12. Terezakis SA, Lovelock DM, Bilsky MH et al (2007) Image-guided intensity-modulated photon radiotherapy using multifractionated regimen to paraspinal chordomas and rare sarcomas. Int J Radiat Oncol Biol Phys 69:1502–1508

    Article  Google Scholar 

  13. DeLaney TF, Liebsch NJ, Pedlow FX et al (2009) Phase II study of high-dose photon/proton radiotherapy in the management of spine sarcomas. Int J Radiat Oncol Biol Phys 74:732–739

    Article  CAS  Google Scholar 

  14. Imai R, Kamada T, Araki N, Working Group for Bone and Soft Tissue Sarcomas (2016) Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases. Int J Radiat Oncol Biol Phys 95:322–327

    Article  Google Scholar 

  15. Sahgal A, Ames C, Chou D et al (2009) Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys 74:723–731

    Article  Google Scholar 

  16. Choi D, Melcher R, Harms J et al (2010) Outcome of 132 operations in 97 patients with chordomas of the craniocervical junction and upper cervical spine. Neurosurg 66:59–65

    Article  Google Scholar 

  17. DeLaney TF, Liebsch NJ, Pedlow FX et al (2014) Long-term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas. J Surg Oncol 110:115–122

    Article  Google Scholar 

  18. Fourney DR, Frangou EM, Ryken TC et al (2011) Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 29:3072–3077

    Article  Google Scholar 

Download references

Funding

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (#18K09067).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoshihiro Matsumoto.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsumoto, Y., Matsunobu, A., Kawaguchi, K. et al. Clinical results of carbon-ion radiotherapy with separation surgery for primary spine/paraspinal sarcomas. Int J Clin Oncol 24, 1490–1497 (2019). https://doi.org/10.1007/s10147-019-01505-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-019-01505-y

Keywords

Navigation