Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

Other Members of the Sacral Tumor Society

Research output: Contribution to journalArticle

Abstract

Background: We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. Methods: A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow-up of 7 ± 4 years. Eighty-nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. Results: The 10-year disease-free and disease-specific survival was 58% and 72%, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.59-2.17; P = 0.71), metastases (HR, 0.93; 95% CI, 0.45-1.91; P = 0.85) or disease-specific survival (HR, 0.96; 95% CI, 0.46-2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95% CI, 0.20-1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95% CI, 1.64-4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95% CI, 1.88-14.38; P < 0.001). Conclusions: In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en-bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.

Original languageEnglish (US)
JournalJournal of Surgical Oncology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Chordoma
Radiotherapy
Confidence Intervals
Radiation
Recurrence
Stress Fractures
Disease-Free Survival
Neoplasms
Neoplasm Metastasis
Survival
Wounds and Injuries

Keywords

  • chordoma
  • outcome
  • radiotherapy
  • sacrum
  • surgical resection

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma. / Other Members of the Sacral Tumor Society.

In: Journal of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

@article{b4c29e84c939441cabada8cfcdee90d3,
title = "Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma",
abstract = "Background: We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. Methods: A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow-up of 7 ± 4 years. Eighty-nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. Results: The 10-year disease-free and disease-specific survival was 58{\%} and 72{\%}, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95{\%} confidence interval [CI], 0.59-2.17; P = 0.71), metastases (HR, 0.93; 95{\%} CI, 0.45-1.91; P = 0.85) or disease-specific survival (HR, 0.96; 95{\%} CI, 0.46-2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95{\%} CI, 0.20-1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95{\%} CI, 1.64-4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95{\%} CI, 1.88-14.38; P < 0.001). Conclusions: In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en-bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.",
keywords = "chordoma, outcome, radiotherapy, sacrum, surgical resection",
author = "{Other Members of the Sacral Tumor Society} and Houdek, {Matthew T.} and Rose, {Peter S.} and Mario Hevesi and Schwab, {Joseph H.} and Griffin, {Anthony M.} and Healey, {John H.} and Petersen, {Ivy A} and DeLaney, {Thomas F.} and Chung, {Peter W.} and Yaszemski, {Michael J} and Wunder, {Jay S.} and Hornicek, {Francis J.} and Boland, {Patrick J.} and Sim, {Franklin H.} and Ferguson, {Peter C.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/jso.25399",
language = "English (US)",
journal = "Journal of Surgical Oncology",
issn = "0022-4790",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

AU - Other Members of the Sacral Tumor Society

AU - Houdek, Matthew T.

AU - Rose, Peter S.

AU - Hevesi, Mario

AU - Schwab, Joseph H.

AU - Griffin, Anthony M.

AU - Healey, John H.

AU - Petersen, Ivy A

AU - DeLaney, Thomas F.

AU - Chung, Peter W.

AU - Yaszemski, Michael J

AU - Wunder, Jay S.

AU - Hornicek, Francis J.

AU - Boland, Patrick J.

AU - Sim, Franklin H.

AU - Ferguson, Peter C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. Methods: A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow-up of 7 ± 4 years. Eighty-nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. Results: The 10-year disease-free and disease-specific survival was 58% and 72%, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.59-2.17; P = 0.71), metastases (HR, 0.93; 95% CI, 0.45-1.91; P = 0.85) or disease-specific survival (HR, 0.96; 95% CI, 0.46-2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95% CI, 0.20-1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95% CI, 1.64-4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95% CI, 1.88-14.38; P < 0.001). Conclusions: In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en-bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.

AB - Background: We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. Methods: A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow-up of 7 ± 4 years. Eighty-nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. Results: The 10-year disease-free and disease-specific survival was 58% and 72%, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.59-2.17; P = 0.71), metastases (HR, 0.93; 95% CI, 0.45-1.91; P = 0.85) or disease-specific survival (HR, 0.96; 95% CI, 0.46-2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95% CI, 0.20-1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95% CI, 1.64-4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95% CI, 1.88-14.38; P < 0.001). Conclusions: In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en-bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.

KW - chordoma

KW - outcome

KW - radiotherapy

KW - sacrum

KW - surgical resection

UR - http://www.scopus.com/inward/record.url?scp=85061297665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061297665&partnerID=8YFLogxK

U2 - 10.1002/jso.25399

DO - 10.1002/jso.25399

M3 - Article

JO - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

SN - 0022-4790

ER -