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Hypofractionated proton and carbon ion beam radiotherapy for sacrococcygeal chordoma (ISAC): an open label, randomized, stratified, phase II trial

Introduction - Sacrococcygeal chordomas have high recurrence rates and are challenging to treat. - Methods - In this phase II prospective, randomized, stratified trial, the safety and feasibility of hypofractionated ion radiation therapy were investigated. The primary focus was monitored through the...

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Main Authors: Seidensaal, Katharina (Author) , Froehlke, Andreas (Author) , Hommertgen, Adriane (Author) , Lehner, Burkhard (Author) , Geisbüsch, Andreas (Author) , Meis, Jan (Author) , Liermann, Jakob (Author) , Kudak, Andreas (Author) , Stein, Katharina (Author) , Uhl, Matthias (Author) , Tessonnier, Thomas (Author) , Mairani, Andrea (Author) , Debus, Jürgen (Author) , Herfarth, Klaus (Author)
Format: Article (Journal)
Language:English
Published: September 2024
In: Radiotherapy and oncology
Year: 2024, Volume: 198, Pages: 1-7
ISSN:1879-0887
DOI:10.1016/j.radonc.2024.110418
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.radonc.2024.110418
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0167814024006881
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Author Notes:Katharina Seidensaal, Andreas Froehlke, Adriane Lentz-Hommertgen, Burkhard Lehner, Andreas Geisbuesch, Jan Meis, Jakob Liermann, Andreas Kudak, Katharina Stein, Matthias Uhl, Thomas Tessonnier, Andrea Mairani, Juergen Debus, Klaus Herfarth
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Summary:Introduction - Sacrococcygeal chordomas have high recurrence rates and are challenging to treat. - Methods - In this phase II prospective, randomized, stratified trial, the safety and feasibility of hypofractionated ion radiation therapy were investigated. The primary focus was monitored through the incidence of Grade 3-5 NCI-CTC-AE toxicity. Secondary endpoints included local progression-free (LPFS) and overall survival (OS). - Results - The study enrolled 82 patients with primary (87 %) and recurrent (13 %) inoperable or incompletely resected sacral chordomas from January 2013 to July 2022, divided equally into proton therapy (Arm A) and carbon ion beam therapy (Arm B) groups, each receiving a total dose of 64 Gy (RBE) in 16 fractions, 5-6 fractions per week. Overall 74 % of patients received no previous surgery and 66 % of tumors were confirmed by a brachyury staining. The mean and median Gross Tumor Volume at the time of treatment (GTV) was 407 ml and 185 ml, respectively. The median follow-up of the surviving patients was 44.7 months, and the 2-year and 4-year OS rates were 96 % and 81 %, respectively. Factors such as smaller GTV and younger age trended towards better OS. The LPFS after 2-year and 4-year was 84 % and 70 %, respectively. Male gender emerged as a significant predictor of LPFS. There was no significant difference between the treatment groups. We observed five grade 4 wound healing disorders (6 %). - Conclusion - The initial response rates were promising; however local control was not sustained. More comparative research on fractionation schemes is essential to refine treatment approaches for inoperable sacral chordoma.
Item Description:Online verfügbar: 27. Juni 2024, Artikelversion: 3. Juli 2024
Gesehen am 10.01.2025
Physical Description:Online Resource
ISSN:1879-0887
DOI:10.1016/j.radonc.2024.110418

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