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Long term results following radiotherapy for high risk giant cell tumours of bone
Proceedings of the 36th Annual ASTRO Meeting
223
121 RADIATION THERAPY FOR CHORDOMAS OF THE BASE OF SKULL AND CERVICAL SPINE: PATTERNS OF FAILURE AND OUTCOME AFTER RELAPSE Depamnent of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, and Cyclotron Laboratory, Harvard University, Cambridge, Massachusetts. Marcio A. Fagundes, M.D.; Eugen B. Hug, M.D.; Norbert J. Liebsch, MD.; William Daly; John E. Munzenrider, M.D. Purpose: To determine the patterns of failure and outcome following relapse of chordomas of the base of skull and cervical spine. Methods and Materials: Between November 1975 and October 1993,204 patients were treated for chotdoma of the base of skull and cervical spine. Subsequently, 64 relapsed constituting the population of this study. All patients underwent combined proton and photon beam in-ad&ion for either primary or locally recurrent disease. Total target doses ranged from 46.0 to 77.4 CGE (CGE= Cobalt Gray Equivalent) with a mean total dose of 69.6 CGE. Mean age was 40 years and patients were followed for a mean interval of 56 months (range 8-158). Results: Among 64 patients, 59 (92%) experienced local failure and in 48/59 (81%), this was the only site of relapse. Two of 64 patients (3%) developed ngional lymph node failure, both associated with distant metastases and 3/64 (5%) developed surgical scar failure (palate 1. nasal cavity 1 and skin/soft tissue 1 patient). Thirteen patients (20%) were diagnosed with distant metastases, most commonly to lung (7/13,54%), and bony sites (6/13 patients, 46%). only l/13 patients failed with isolated distant metastases. Actuarial overall survival rates following local failure (59 patients) were 42% (3 years) and 5% (5 years). After distant failure (13 patients) the respective survival rates were 23% and 0%. After any failure (64 patients) 42% were alive at 3 years and 7% at 5 years. Following locai relapse, 49/59 patients (83%) underwent salvage therapy, consisting of subtotal surgical resection in most patients (47/49). Gf these, 4 also received systemic chemotherapy. The remainin g 10 patients (17%) received supportive care. Salvage therapy resulted in stabilization or clinical improvement, but subsequent progression in U/49 (55%). In 14/49 (29%) clinical symptoms were progressive. Salvage therapy resulted in stable or improved status without subsequent progression in only 8/49 patients (16%). Actuarial overall survival comparmg salvage treanrrent vs supportive cam was 65% and 11% at 2 years, decreasing fwther to 9% and 0% at 5 years. Conclusions: Local faihtre is the predominant site of relapse for chonlomas of the base of skull and cervical spine following definitive radiation treatment. Isolated distant memstams are tare, although 20% of patients who relapsed in thii series had distant spread as a component of failure pattern. Salvage thempy can improve short-term survival and possibly quality of life however, most patients will ultJrnately succumb to their disease. Poor long-term survival rates following relapse emphasize the need to maximize treatment of the primary site, as for most patients, only permanent local control can offer a chance of cure.
122 LONG TERM RESULTS FOLLGWING RADIGTHE~Y
FOR HIGH RISK GIANT CELL TUMOURS OF BONE.
Malone, S., O’Sullivan, B., Catton, C., Bell, R., Fomasier, V., Davis, A. The Princess Margaret Hospital, Toronto, Canada.
Purpose:
Giant Cell Ttmtours of Bone are rare and have a variable presentation and natural history. There may be significant functional sequelae as a result of their locally aggressive nature or as a result of treatment. We reviewed the long term results of tadiothempy for high risk grant cell tumours m order to assess the following: the efficacy of radiotherapy, the potential late toxicity of treatment and to determine indications for radiation tmannent.
Materials & Methods: This reportis a retrospective review of 22 localized Giant Cell Tumours of Bone treated with radiotherapy between 1944 and 1991. Radiation was used in the primary management in 14 cases and for mcmrent disease in 8. In the primary cases, 3 received radiotherapy as the sole modality ( including 2 massive pelvic lesions and an advanced maxilhuy sinus tumour with orbital and pterygoid invasion ) Fd in the other 11, 3 had gross residual disease following surgery, and 8 had microscopic residual disease. of 8 tecurrent cases, 5 were treated wrth radiotherapy alone and 3 with combined surgery and radiation. Sites of origin included extmmity bones in 9 cases, pelvis in 7, spine in 4 and skull in 2. Extraosseous disease was apparent in 18 ttmroms and extended to contiguous structures in 14 (including 4 cases of spinal cord compression, 3 cases of sacral plexopathy and one patient with tempmal lobe invasion). The most common dose regimen was 35 Gy / 15 fractions / 3 weeks (14 cases) with varying schedules for the remainder.
Results: Mean follow-up time was 16.5 years ( 2 to 46 yrs ). Local control was achieved in 20 of 22 patients with radiotherapy. The 2 failures were subsequently salvaged for an ultimate local control rate of 100%. One of the 2 radiotherapy failures was a marginal failure and was subsequently salvaged with combined surgery and radiotherapy. No patient died of Giant cell Tumour. Radiotherapy was well tolerated witb no serious late toxicity. There were no cases of malignant transformation or radiation induced cancer. Conclusion: Long-term results in this series indicate that radiotherapy in moderate doses ( 35 Gy in 15 fractions or equivalent ) is a safe and effective option for primary and recurrent Giant Cell Turnouts of Bone. Radiotherapy should be used if surgery would result in significant functional morbidity and should also be. considered in select sites where the probability of recurrence is high and there is potential for significant morbidity from tumor relapse or subsequent surgery.
223
121 RADIATION THERAPY FOR CHORDOMAS OF THE BASE OF SKULL AND CERVICAL SPINE: PATTERNS OF FAILURE AND OUTCOME AFTER RELAPSE Depamnent of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, and Cyclotron Laboratory, Harvard University, Cambridge, Massachusetts. Marcio A. Fagundes, M.D.; Eugen B. Hug, M.D.; Norbert J. Liebsch, MD.; William Daly; John E. Munzenrider, M.D. Purpose: To determine the patterns of failure and outcome following relapse of chordomas of the base of skull and cervical spine. Methods and Materials: Between November 1975 and October 1993,204 patients were treated for chotdoma of the base of skull and cervical spine. Subsequently, 64 relapsed constituting the population of this study. All patients underwent combined proton and photon beam in-ad&ion for either primary or locally recurrent disease. Total target doses ranged from 46.0 to 77.4 CGE (CGE= Cobalt Gray Equivalent) with a mean total dose of 69.6 CGE. Mean age was 40 years and patients were followed for a mean interval of 56 months (range 8-158). Results: Among 64 patients, 59 (92%) experienced local failure and in 48/59 (81%), this was the only site of relapse. Two of 64 patients (3%) developed ngional lymph node failure, both associated with distant metastases and 3/64 (5%) developed surgical scar failure (palate 1. nasal cavity 1 and skin/soft tissue 1 patient). Thirteen patients (20%) were diagnosed with distant metastases, most commonly to lung (7/13,54%), and bony sites (6/13 patients, 46%). only l/13 patients failed with isolated distant metastases. Actuarial overall survival rates following local failure (59 patients) were 42% (3 years) and 5% (5 years). After distant failure (13 patients) the respective survival rates were 23% and 0%. After any failure (64 patients) 42% were alive at 3 years and 7% at 5 years. Following locai relapse, 49/59 patients (83%) underwent salvage therapy, consisting of subtotal surgical resection in most patients (47/49). Gf these, 4 also received systemic chemotherapy. The remainin g 10 patients (17%) received supportive care. Salvage therapy resulted in stabilization or clinical improvement, but subsequent progression in U/49 (55%). In 14/49 (29%) clinical symptoms were progressive. Salvage therapy resulted in stable or improved status without subsequent progression in only 8/49 patients (16%). Actuarial overall survival comparmg salvage treanrrent vs supportive cam was 65% and 11% at 2 years, decreasing fwther to 9% and 0% at 5 years. Conclusions: Local faihtre is the predominant site of relapse for chonlomas of the base of skull and cervical spine following definitive radiation treatment. Isolated distant memstams are tare, although 20% of patients who relapsed in thii series had distant spread as a component of failure pattern. Salvage thempy can improve short-term survival and possibly quality of life however, most patients will ultJrnately succumb to their disease. Poor long-term survival rates following relapse emphasize the need to maximize treatment of the primary site, as for most patients, only permanent local control can offer a chance of cure.
122 LONG TERM RESULTS FOLLGWING RADIGTHE~Y
FOR HIGH RISK GIANT CELL TUMOURS OF BONE.
Malone, S., O’Sullivan, B., Catton, C., Bell, R., Fomasier, V., Davis, A. The Princess Margaret Hospital, Toronto, Canada.
Purpose:
Giant Cell Ttmtours of Bone are rare and have a variable presentation and natural history. There may be significant functional sequelae as a result of their locally aggressive nature or as a result of treatment. We reviewed the long term results of tadiothempy for high risk grant cell tumours m order to assess the following: the efficacy of radiotherapy, the potential late toxicity of treatment and to determine indications for radiation tmannent.
Materials & Methods: This reportis a retrospective review of 22 localized Giant Cell Tumours of Bone treated with radiotherapy between 1944 and 1991. Radiation was used in the primary management in 14 cases and for mcmrent disease in 8. In the primary cases, 3 received radiotherapy as the sole modality ( including 2 massive pelvic lesions and an advanced maxilhuy sinus tumour with orbital and pterygoid invasion ) Fd in the other 11, 3 had gross residual disease following surgery, and 8 had microscopic residual disease. of 8 tecurrent cases, 5 were treated wrth radiotherapy alone and 3 with combined surgery and radiation. Sites of origin included extmmity bones in 9 cases, pelvis in 7, spine in 4 and skull in 2. Extraosseous disease was apparent in 18 ttmroms and extended to contiguous structures in 14 (including 4 cases of spinal cord compression, 3 cases of sacral plexopathy and one patient with tempmal lobe invasion). The most common dose regimen was 35 Gy / 15 fractions / 3 weeks (14 cases) with varying schedules for the remainder.
Results: Mean follow-up time was 16.5 years ( 2 to 46 yrs ). Local control was achieved in 20 of 22 patients with radiotherapy. The 2 failures were subsequently salvaged for an ultimate local control rate of 100%. One of the 2 radiotherapy failures was a marginal failure and was subsequently salvaged with combined surgery and radiotherapy. No patient died of Giant cell Tumour. Radiotherapy was well tolerated witb no serious late toxicity. There were no cases of malignant transformation or radiation induced cancer. Conclusion: Long-term results in this series indicate that radiotherapy in moderate doses ( 35 Gy in 15 fractions or equivalent ) is a safe and effective option for primary and recurrent Giant Cell Turnouts of Bone. Radiotherapy should be used if surgery would result in significant functional morbidity and should also be. considered in select sites where the probability of recurrence is high and there is potential for significant morbidity from tumor relapse or subsequent surgery.