TY - JOUR
T1 - Les chordomes de la base du crâne et du rachis cervical haut. À propos d'une série de 100 patients irradiés selon une technique conformationnelle 3D par une association de faisceaux de photons et de protons
AU - Noël, G.
AU - Feuvret, L.
AU - Dhermain, F.
AU - Mammar, H.
AU - Haie-Méder, C.
AU - Ponvert, D.
AU - Hasboun, D.
AU - Ferrand, R.
AU - Nauraye, C.
AU - Boisserie, G.
AU - Beaudré, A.
AU - Gaboriaud, G.
AU - Mazal, A.
AU - Touboul, E.
AU - Habrand, J. L.
AU - Mazeron, J. J.
PY - 2005/5/1
Y1 - 2005/5/1
N2 - Objective. - To define prognostic factors for local control and survival in 100 consecutive patients treated by fractionated photon and proton radiation for chordoma of the skull base and upper cervical spine. Patients and methods. - Between December 1995 and August 2002, 100 patients (median age: 53 years, range: 8-85, M/F sex-ratio: 3/2), were treated by a combination of high-energy photons and protons. The proton component was delivered by the 201 MeV proton beam of the Centre de Protonthérapie d'Orsay (CPO). The median total dose delivered to the gross tumour volume was 67 Cobalt Gray Equivalent (CGE) (range: 60-71). A complete surgery, incomplete surgery or a biopsy was performed before the radiotherapy in 16, 75 and 9 cases, respectively. Results. With a median follow-up of 31 months (range: 1-87), 25 tumours failed locally. The 2 and 4-year local control rates were 86.3% ( ± 3.9%) and 53.8% ( ± 7.5%), respectively. According to multivariate analysis, less than 95% of the tumour volume encompassed by the 95% isodose line (P = 0.048; RR: 3.4 IC95% [1.01-11.8]) and a minimal dose less than 56 CGE (p = 0.042; RR: 2.3 IC95% [1.03-5.2]) were independent prognostic factors of local control. Ten patients died. The 2 and 5-year overall survival rates were 94.3% ( ± 2.5%) and 80.5% ( ± 7.2%). According to multivariate analysis, a controlled tumour (P = 0.005; RR: 21 IC95% [2.2-200]) was the lonely independent favourable prognostic factor for overall survival. Conclusion. - In chordomas of the skull base and upper cervical spine treated by surgical resection followed by high-dose photon and proton irradiation, local control is mainly dependent on the quality of radiation, especially dose-uniformity within the gross tumour volume. Special attention must be paid to minimise underdosed areas due to the close proximity of critical structures and possibly escalate dose-constraints to tumour targets in future studies, in view of the low toxicity observed to date.
AB - Objective. - To define prognostic factors for local control and survival in 100 consecutive patients treated by fractionated photon and proton radiation for chordoma of the skull base and upper cervical spine. Patients and methods. - Between December 1995 and August 2002, 100 patients (median age: 53 years, range: 8-85, M/F sex-ratio: 3/2), were treated by a combination of high-energy photons and protons. The proton component was delivered by the 201 MeV proton beam of the Centre de Protonthérapie d'Orsay (CPO). The median total dose delivered to the gross tumour volume was 67 Cobalt Gray Equivalent (CGE) (range: 60-71). A complete surgery, incomplete surgery or a biopsy was performed before the radiotherapy in 16, 75 and 9 cases, respectively. Results. With a median follow-up of 31 months (range: 1-87), 25 tumours failed locally. The 2 and 4-year local control rates were 86.3% ( ± 3.9%) and 53.8% ( ± 7.5%), respectively. According to multivariate analysis, less than 95% of the tumour volume encompassed by the 95% isodose line (P = 0.048; RR: 3.4 IC95% [1.01-11.8]) and a minimal dose less than 56 CGE (p = 0.042; RR: 2.3 IC95% [1.03-5.2]) were independent prognostic factors of local control. Ten patients died. The 2 and 5-year overall survival rates were 94.3% ( ± 2.5%) and 80.5% ( ± 7.2%). According to multivariate analysis, a controlled tumour (P = 0.005; RR: 21 IC95% [2.2-200]) was the lonely independent favourable prognostic factor for overall survival. Conclusion. - In chordomas of the skull base and upper cervical spine treated by surgical resection followed by high-dose photon and proton irradiation, local control is mainly dependent on the quality of radiation, especially dose-uniformity within the gross tumour volume. Special attention must be paid to minimise underdosed areas due to the close proximity of critical structures and possibly escalate dose-constraints to tumour targets in future studies, in view of the low toxicity observed to date.
KW - 3D radiotherapy
KW - Chordoma
KW - Protontherapy
UR - http://www.scopus.com/inward/record.url?scp=22144463512&partnerID=8YFLogxK
U2 - 10.1016/j.canrad.2005.04.005
DO - 10.1016/j.canrad.2005.04.005
M3 - Article
C2 - 15979920
AN - SCOPUS:22144463512
SN - 1278-3218
VL - 9
SP - 161
EP - 174
JO - Cancer/Radiotherapie
JF - Cancer/Radiotherapie
IS - 3
ER -