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.
References
Catton C, O'Sullivan B, Bell R et al (1996) Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 41:67–72
Matsunobu A, Imai R, Kamada T et al (2012) Impact of carbon ion radiotherapy for unresectable osteosarcoma of the trunk. Cancer 118:4555–4563
Matsumoto K, Imai R, Kamada T et al (2013) Impact of carbon ion radiotherapy for primary spinal sarcoma. Cancer 119:3496–3503
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Corresponding author
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
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-019-01505-y