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Takemori T, Hara H, Kawamoto T, Fukase N, Sawada R, Fujiwara S, Fujita I, Fujimoto T, Morishita M, Yahiro S, Miyamoto T, Saito M, Sugaya J, Hayashi K, Kawashima H, Torigoe T, Nakamura T, Kondo H, Wakamatsu T, Watanuki M, Kito M, Tsukushi S, Nagano A, Outani H, Toki S, Nishimura S, Kobayashi H, Watanabe I, Demizu Y, Sasaki R, Fukumoto T, Matsumoto T, Kuorda R, Akisue T. Comparison of clinical outcome between surgical treatment and particle beam therapy for pelvic bone sarcomas: A retrospective multicenter study in Japan. J Orthop Sci 2024:S0949-2658(24)00108-8. [PMID: 38964957 DOI: 10.1016/j.jos.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Few studies have compared the clinical outcomes of patients with pelvic bone sarcomas treated surgically and those treated with particle beam therapy. This is a multicenter retrospective cohort study which compared the clinical outcomes of patients with pelvic bone sarcoma who underwent surgical treatment and particle beam therapy in Japan. METHODS A total of 116 patients with pelvic bone sarcoma treated at 19 specialized sarcoma centers in Japan were included in this study. Fifty-seven patients underwent surgery (surgery group), and 59 patients underwent particle beam therapy (particle beam group; carbon-ion radiotherapy: 55 patients, proton: four patients). RESULTS The median age at primary tumor diagnosis was 52 years in the surgery group and 66 years in the particle beam group (P < 0.001), and the median tumor size was 9 cm in the surgery group and 8 cm in the particle beam group (P = 0.091). Overall survival (OS), local control (LC), and metastasis-free survival (MFS) rates were evaluated using the Kaplan-Meier method and compared among 116 patients with bone sarcoma (surgery group, 57 patients; particle beam group, 59 patients). After propensity score matching, the 3-year OS, LC, and MFS rates were 82.9% (95% confidence interval [CI], 60.5-93.2%), 66.0% (95% CI, 43.3-81.3%), and 78.4% (95% CI, 55.5-90.5%), respectively, in the surgery group and 64.9% (95% CI, 41.7-80.8%), 86.4% (95% CI, 63.3-95.4%), and 62.6% (95% CI, 38.5-79.4%), respectively, in the particle beam group. In chordoma patients, only surgery was significantly correlated with worse LC in the univariate analysis. CONCLUSIONS The groups had no significant differences in the OS, LC, and MFS rates. Among the patients with chordomas, the 3-year LC rate in the particle beam group was significantly higher than in the surgery group.
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Affiliation(s)
- Toshiyuki Takemori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan.
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; Division of Orthopaedic Surgery, Kobe University Hospital, International Clinical Cancer Research Center, Kobe 650-0047, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Ryoko Sawada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Shuichi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Ikuo Fujita
- Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan
| | - Takuya Fujimoto
- Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan
| | - Masayuki Morishita
- Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan
| | - Shunsuke Yahiro
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Tomohiro Miyamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Masanori Saito
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Jun Sugaya
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hiroyuki Kawashima
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Tomoaki Torigoe
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan
| | - Hiroya Kondo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama University, Okayama 700-8558, Japan
| | - Toru Wakamatsu
- Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Munenori Watanuki
- Department of Orthopaedic Surgery, School of Medicine, Tohoku University, Sendai 980-8574, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Matsumoto 390-8621, Japan
| | - Satoshi Tsukushi
- Department of Orthopaedic Surgery, Aichi Cancer Center Hospital, Nagoya 464-0021, Japan
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University, Gifu 501-1194, Japan
| | - Hidetatsu Outani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Shunichi Toki
- Department of Orthopaedics, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8503, Japan
| | - Shunji Nishimura
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama 589-8511, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Itsuo Watanabe
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa 272-8513, Japan
| | - Yusuke Demizu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe 650-0047, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Ryosuke Kuorda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
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Seidensaal K, Froehlke A, Lentz-Hommertgen A, Lehner B, Geisbuesch A, Meis J, Liermann J, Kudak A, Stein K, Uhl M, Tessonnier T, Mairani A, Debus J, Herfarth K. Hypofractionated proton and carbon ion beam radiotherapy for sacrococcygeal chordoma (ISAC): An open label, randomized, stratified, phase II trial. Radiother Oncol 2024; 198:110418. [PMID: 38944346 DOI: 10.1016/j.radonc.2024.110418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
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.
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Affiliation(s)
- Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Andreas Froehlke
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Burkhard Lehner
- Center for Orthopedics, Trauma Surgery and Paraplegiology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Geisbuesch
- Center for Orthopedics, Trauma Surgery and Paraplegiology, University of Heidelberg, Heidelberg, Germany
| | - Jan Meis
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Kudak
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Department of Radiation Oncology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Katharina Stein
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Department of Radiation Oncology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Uhl
- Department of Radiation Oncology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Tessonnier
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrea Mairani
- National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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Weidlich A, Schaser KD, Weitz J, Kirchberg J, Fritzmann J, Reeps C, Schwabe P, Melcher I, Disch A, Dragu A, Winkler D, Mehnert E, Fritzsche H. Surgical and Oncologic Outcome following Sacrectomy for Primary Malignant Bone Tumors and Locally Recurrent Rectal Cancer. Cancers (Basel) 2024; 16:2334. [PMID: 39001396 PMCID: PMC11240444 DOI: 10.3390/cancers16132334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Bone sarcoma or direct pelvic carcinoma invasion of the sacrum represent indications for partial or total sacrectomy. The aim was to describe the oncosurgical management and complication profile and to analyze our own outcome results following sacrectomy. METHODS In a retrospective analysis, 27 patients (n = 8/10/9 sarcoma/chordoma/locally recurrent rectal cancer (LRRC)) were included. There was total sacrectomy in 9 (incl. combined L5 en bloc spondylectomy in 2), partial in 10 and hemisacrectomy in 8 patients. In 12 patients, resection was navigation-assisted. For reconstruction, an omentoplasty, VRAM-flap or spinopelvic fixation was performed in 20, 10 and 13 patients, respectively. RESULTS With a median follow-up (FU) of 15 months, the FU rate was 93%. R0-resection was seen in 81.5% (no significant difference using navigation), and 81.5% of patients suffered from one or more minor-to-moderate complications (especially wound-healing disorders/infection). The median overall survival was 70 months. Local recurrence occurred in 20%, while 44% developed metastases and five patients died of disease. CONCLUSIONS Resection of sacral tumors is challenging and associated with a high complication profile. Interdisciplinary cooperation with visceral/vascular and plastic surgery is essential. In chordoma patients, systemic tumor control is favorable compared to LRRC and sarcomas. Navigation offers gain in intraoperative orientation, even if there currently seems to be no oncological benefit. Complete surgical resection offers long-term survival to patients undergoing sacrectomy for a variety of complex diseases.
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Affiliation(s)
- Anne Weidlich
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Klaus-Dieter Schaser
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Johanna Kirchberg
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Johannes Fritzmann
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Philipp Schwabe
- Department for Trauma and Orthopedic Surgery, Center for Musculoskeletal Tumor Medicine, Vivantes Hospital Spandau, 13585 Berlin, Germany
| | - Ingo Melcher
- Department for Trauma and Orthopedic Surgery, Center for Musculoskeletal Tumor Medicine, Vivantes Hospital Spandau, 13585 Berlin, Germany
| | - Alexander Disch
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Adrian Dragu
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Doreen Winkler
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Elisabeth Mehnert
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Hagen Fritzsche
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
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Endo M. Creation, evolution, and future challenges of ion beam therapy from a medical physicist's viewpoint (Part 3): Chapter 3. Clinical research, Chapter 4. Future challenges, Chapter 5. Discussion, and Conclusion. Radiol Phys Technol 2023; 16:443-470. [PMID: 37882992 DOI: 10.1007/s12194-023-00748-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
Clinical studies of ion beam therapy have been performed at the Lawrence Berkeley Laboratory (LBL), National Institute of Radiological Sciences (NIRS), Gesellschaft für Schwerionenforschung (GSI), and Deutsches Krebsforschungszentrum (DKFZ), in addition to the development of equipment, biophysical models, and treatment planning systems. Although cancers, including brain tumors and pancreatic cancer, have been treated with the Bevalac's neon-ion beam at the LBL (where the first clinical research was conducted), insufficient results were obtained owing to the limited availability of neon-ion beams and immaturity of related technologies. However, the 184-Inch Cyclotron's helium-ion beam yielded promising results for chordomas and chondrosarcomas at the base of the skull. Using carbon-ion beams, NIRS has conducted clinical trials for the treatment of common cancers for which radiotherapy is indicated. Because better results than X-ray therapy results have been obtained for lung, liver, pancreas, and prostate cancers, as well as pelvic recurrences of rectal cancer, the Japanese government recently approved the use of public medical insurance for carbon-ion radiotherapy, except for lung cancer. GSI obtained better results than LBL for bone and soft tissue tumors, owing to dose enhancement enabled by scanning irradiation. In addition, DKFZ compared treatment results of proton and carbon-ion radiotherapy for these tumors. This article summarizes a series of articles (Parts 1-3) and describes future issues of immune ion beam therapy and linear energy transfer optimization.
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Affiliation(s)
- Masahiro Endo
- Association for Nuclear Technology in Medicine, Nikkei Bldg., 7-16 Nihombashi-Kodemmacho, Chuo-ku, Tokyo, 103-0001, Japan.
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Zhang L, Akiyama T, Ohno T. ASO Author Reflections: Long-Term Perspective in Choosing Between Carbon-Ion Radiotherapy and Surgery for Malignant Pelvic Bone Tumors. Ann Surg Oncol 2023; 30:4485-4486. [PMID: 36853564 DOI: 10.1245/s10434-023-13293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Liuzhe Zhang
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya Ward, Saitama, 330-0834, Japan
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya Ward, Saitama, 330-0834, Japan.
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
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Zhang L, Akiyama T, Saito M, Okamoto M, Gokita T, Kobayashi H, Ae K, Ohno T. Complications and Functional Outcome Differences in Carbon Ion Radiotherapy and Surgery for Malignant Bone Tumors of the Pelvis: A Multicenter, Cohort Study. Ann Surg Oncol 2023; 30:4475-4484. [PMID: 36853566 DOI: 10.1245/s10434-023-13226-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Carbon ion radiotherapy (CIRT) is an evolving treatment option for malignant pelvic tumors in patients with poor surgical indications. However, the difference in complications and functional outcomes between CIRT and surgery is poorly understood. This study compares the complications and functional outcomes of CIRT and surgery to facilitate treatment selection. METHODS A total of 28 patients who underwent CIRT for pelvic bone tumors while theoretically meeting the surgical resection criteria were included. Sixty-nine patients who underwent surgery for pelvic bone tumors were included as controls. Major complication rates and functional outcomes (ambulatory, pain, urination, constipation) were evaluated and compared at several time points (pretreatment, discharge, and final follow-up) between the groups. RESULTS Early (within 90 days) major complications were not observed in the CIRT group but occurred in 30% of the surgery group, which was statistically significant (P < 0.001). In contrast, late (after 90 days) major complications occurred more often in the CIRT group than in the surgery group (18% and 4%, respectively; P = 0.042). From pretreatment until discharge, all functional outcomes in the surgery group deteriorated (P < 0.001 for all) but did not change in the CIRT group (P = 0.77-1.00). At the final follow-up, all functional outcomes showed no significant intergroup difference (P = 0.28-0.92) due to the recovery trend in the surgery group and the deterioration trend in the CIRT group. CONCLUSIONS Compared with surgery, CIRT may have favorable safety and stable functional outcomes in the short-term but more late complications. Mid-term functional outcomes were similar between the groups.
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Affiliation(s)
- Liuzhe Zhang
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| | - Masanori Saito
- Department of Orthopedic Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Tabu Gokita
- Department of Orthopedic Oncology, Saitama Cancer Center, Saitama, Japan
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keisuke Ae
- Department of Orthopedic Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
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Hoppe BS, Petersen IA, Wilke BK, DeWees TA, Imai R, Hug EB, Fiore MR, Debus J, Fossati P, Yamada S, Orlandi E, Zhang Q, Bao C, Seidensaal K, May BC, Harrell AC, Houdek MT, Vallow LA, Rose PS, Haddock MG, Ashman JB, Goulding KA, Attia S, Krishnan S, Mahajan A, Foote RL, Laack NN, Keole SR, Beltran CJ, Welch EM, Karim M, Ahmed SK. Pragmatic, Prospective Comparative Effectiveness Trial of Carbon Ion Therapy, Surgery, and Proton Therapy for the Management of Pelvic Sarcomas (Soft Tissue/Bone) Involving the Bone: The PROSPER Study Rationale and Design. Cancers (Basel) 2023; 15:1660. [PMID: 36980545 PMCID: PMC10046156 DOI: 10.3390/cancers15061660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
Surgical treatment of pelvic sarcoma involving the bone is the standard of care but is associated with several sequelae and reduced functional quality of life (QOL). Treatment with photon and proton radiotherapy is associated with relapse. Carbon ion radiotherapy (CIRT) may reduce both relapse rates and treatment sequelae. The PROSPER study is a tricontinental, nonrandomized, prospective, three-arm, pragmatic trial evaluating treatments of pelvic sarcoma involving the bone. Patients aged at least 15 years are eligible for inclusion. Participants must have an Eastern Cooperative Oncology Group Performance Status score of two or less, newly diagnosed disease, and histopathologic confirmation of pelvic chordoma, chondrosarcoma, osteosarcoma, Ewing sarcoma with bone involvement, rhabdomyosarcoma (RMS) with bone involvement, or non-RMS soft tissue sarcoma with bone involvement. Treatment arms include (1) CIRT (n = 30) delivered in Europe and Asia, (2) surgical treatment with or without adjuvant radiotherapy (n = 30), and (3) proton therapy (n = 30). Arms two and three will be conducted at Mayo Clinic campuses in Arizona, Florida, and Minnesota. The primary end point is to compare the 1-year change in functional QOL between CIRT and surgical treatment. Additional comparisons among the three arms will be made between treatment sequelae, local control, and other QOL measures.
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Affiliation(s)
- Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ivy A. Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin K. Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Todd A. DeWees
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, AZ 85054, USA
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Reiko Imai
- Division of Radiation Oncology, QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Eugen B. Hug
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
| | - Maria Rosaria Fiore
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Piero Fossati
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
- Department for Basic and Translational Oncology and Hematology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Shigeru Yamada
- Division of Radiation Oncology, QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201102, China
| | - Cihang Bao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201102, China
| | - Katharina Seidensaal
- Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Byron C. May
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna C. Harrell
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Matthew T. Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Steven Attia
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas Health Houston Neurosciences-Texas Medical Center, Houston, TX 77030, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Sameer R. Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Eric M. Welch
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mohammed Karim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
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8
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Rose PS. The management of sacral tumours. Bone Joint J 2022; 104-B:1284-1291. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0734.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Tumours of the sacrum are difficult to manage. The sacrum provides the structural connection between the torso and lower half of the body and is subject to both axial and rotational forces. Thus, tumours or their treatment can compromise the stability of the spinopelvic junction. Additionally, nerves responsible for lower limb motor groups as well as bowel, bladder, and sexual function traverse or abut the sacrum. Preservation or sacrifice of these nerves in the treatment of sacral tumours has profound implications on the function and quality of life of the patient. This annotation will discuss current treatment protocols for sacral tumours. Cite this article: Bone Joint J 2022;104-B(12):1284–1291.
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Affiliation(s)
- Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Journal of the American Academy of Orthopaedic Surgeons, Rosemont, Illinois, USA
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9
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Takemori T, Kawamoto T, Hara H, Fukase N, Fujiwara S, Fujita I, Fujimoto T, Morishita M, Kitayama K, Yahiro S, Miyamoto T, Saito M, Sugaya J, Hayashi K, Kawashima H, Torigoe T, Nakamura T, Kondo H, Wakamatsu T, Watanuki M, Kito M, Tsukushi S, Nagano A, Outani H, Toki S, Nishimura S, Kobayashi H, Watanabe I, Demizu Y, Sasaki R, Fukumoto T, Niikura T, Kuroda R, Akisue T. Clinical Outcome of Patients with Pelvic and Retroperitoneal Bone and Soft Tissue Sarcoma: A Retrospective Multicenter Study in Japan. Cancers (Basel) 2022; 14:cancers14123023. [PMID: 35740688 PMCID: PMC9221521 DOI: 10.3390/cancers14123023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary We aimed to clarify the clinical outcomes of patients with pelvic and retroperitoneal bone and soft tissue sarcoma. The 3-year overall survival (OS), local control (LC) rate, and progression-free survival (PFS) were 71.7%, 79.1%, and 48.6%, respectively. The most influential poor prognostic factor for OS was distant metastasis, and for PFS, this was higher age (≥60 years). Larger primary tumor size (≥10 cm) was the only poor prognostic factor for LC. In the histological analysis, osteosarcoma showed significantly worse OS and PFS than other sarcomas in the pelvis and retroperitoneum. Abstract This study aimed to retrospectively analyze the clinical outcomes of patients with pelvic and retroperitoneal bone and soft tissue sarcoma (BSTS). Overall, 187 patients with BSTS in the pelvis and retroperitoneal region treated at 19 specialized sarcoma centers in Japan were included. The prognostic factors related to overall survival (OS), local control (LC), and progression-free survival (PFS) were evaluated. The 3-year OS and LC rates in the 187 patients were 71.7% and 79.1%, respectively. The 3-year PFS in 166 patients without any distant metastases at the time of primary tumor diagnosis was 48.6%. Osteosarcoma showed significantly worse OS and PFS than other sarcomas of the pelvis and retroperitoneum. In the univariate analyses, larger primary tumor size, soft tissue tumor, distant metastasis at the time of primary tumor diagnosis, P2 location, chemotherapy, and osteosarcoma were poor prognostic factors correlated with OS. Larger primary tumor size, higher age, soft tissue tumor, chemotherapy, and osteosarcoma were poor prognostic factors correlated with PFS in patients without any metastasis at the initial presentation. Larger primary tumor size was the only poor prognostic factor correlation with LC. This study has clarified the epidemiology and prognosis of patients with pelvic and retroperitoneal BSTS in Japan.
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Affiliation(s)
- Toshiyuki Takemori
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
- Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan; (I.F.); (T.F.); (M.M.)
| | - Teruya Kawamoto
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
- Division of Orthopaedic Surgery, Kobe University Hospital, International Clinical Cancer Research Center, Kobe 650-0047, Japan
- Correspondence: ; Tel.: +81-783825985
| | - Hitomi Hara
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Naomasa Fukase
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Shuichi Fujiwara
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Ikuo Fujita
- Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan; (I.F.); (T.F.); (M.M.)
| | - Takuya Fujimoto
- Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan; (I.F.); (T.F.); (M.M.)
| | - Masayuki Morishita
- Department of Orthopaedic Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan; (I.F.); (T.F.); (M.M.)
| | - Kazumichi Kitayama
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Shunsuke Yahiro
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Tomohiro Miyamoto
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Masanori Saito
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Jun Sugaya
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan;
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan;
| | - Hiroyuki Kawashima
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan;
| | - Tomoaki Torigoe
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan;
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan;
| | - Hiroya Kondo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama University, Okayama 700-8558, Japan;
| | - Toru Wakamatsu
- Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka 541-8567, Japan;
| | - Munenori Watanuki
- Department of Orthopaedic Surgery, School of Medicine, Tohoku University, Sendai 980-8574, Japan;
| | - Munehisa Kito
- Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Matsumoto 390-8621, Japan;
| | - Satoshi Tsukushi
- Department of Orthopaedic Surgery, Aichi Cancer Center Hospital, Nagoya 464-0021, Japan;
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University, Gifu 501-1194, Japan;
| | - Hidetatsu Outani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan;
| | - Shunichi Toki
- Department of Orthopaedics, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8503, Japan;
| | - Shunji Nishimura
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama 589-8511, Japan;
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
| | - Itsuo Watanabe
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa 272-8513, Japan;
| | - Yusuke Demizu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe 650-0047, Japan;
| | - Ryohei Sasaki
- Division of Radiation Oncology, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan;
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan;
| | - Takahiro Niikura
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Ryosuke Kuroda
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
| | - Toshihiro Akisue
- Department of Orthoapedic Surgery, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan; (T.T.); (H.H.); (N.F.); (S.F.); (K.K.); (S.Y.); (T.M.); (T.N.); (R.K.); (T.A.)
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
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