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Rarer Bone Tumors. Thomas F. DeLaney, M.D. Co-Director: Sarcoma Program Medical Director: F. H. Burr Proton Center Massachusetts General Hospital. Overall survival for all 171 pts was: 48% at 1 year 24% at 2 years 12% at 3 years 6% at 4 years 2% at 5 years - PowerPoint PPT Presentation
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Rarer Bone Tumors
Thomas F. DeLaney, M.D.Co-Director: Sarcoma Program
Medical Director: F. H. Burr Proton CenterMassachusetts General Hospital
Survival-Advanced InoperableChondrosarcoma (Picci et al)Survival-Advanced InoperableChondrosarcoma (Picci et al)
Overall survival for all 171 pts was:
48% at 1 year
24% at 2 years
12% at 3 years
6% at 4 years
2% at 5 years
Median time to death was 11 months-
Useful benchmark for future studies
Overall survival for all 171 pts was:
48% at 1 year
24% at 2 years
12% at 3 years
6% at 4 years
2% at 5 years
Median time to death was 11 months-
Useful benchmark for future studies
0
,2
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1
0 12 24 36 48 60 72 84 96 108 120months
0
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,8
1
Cum
. S
urvi
val
0 12 24 36 48 60 72 84 96 108 120months
OS and stage of inoperable diseaseOS and stage of inoperable disease
P-Value 0.0049P-Value 0.0049
multiple sites
lung only
local + lung
local only
OS and Medical Treatment (all pts) OS and Medical Treatment (all pts)
P-Value 0.0487P-Value 0.0487
Pts with metastasis only (local & local + met excluded)Pts with metastasis only (local & local + met excluded)
P-Value 0.0082P-Value 0.0082
0
,2
,4
,6
,8
1
0 12 24 36 48 60months
Cum
. S
urvi
val
Cum. Survival (YES)
Cum. Survival (NO)
0
,2
,4
,6
,8
1
0 12 24 36 48 60 72 84 96 108 120months
Cum. Survival (YES)
Cum. Survival (NO)
Cum
. S
urvi
val
0
,2
,4
,6
,8
1
0 12 24 36 48 60 72 84 96 108 120months
0
,2
,4
,6
,8
1
0 12 24 36 48 60 72 84 96 108 120
months
0
,2
,4
,6
,8
1
0 12 24 36 48 60 72 84 96 108 120months
OS and Radiotherapy (all pts) OS and Radiotherapy (all pts)
P-Value0.1052P-Value0.1052
OS and Radiotherapy (Local only)OS and Radiotherapy (Local only)P-Value 0.0032P-Value 0.0032
OS and Radiotherapy (Local + met)OS and Radiotherapy (Local + met)
P-Value0.1063P-Value0.1063
Cum. Survival (YES)Cum. Survival (NO)
Cum. Survival (YES)
Cum. Survival (NO)
Cum. Survival (YES)
Cum. Survival (NO)
Cum
. Sur
viva
l
High-Dose Single-Fraction RTfor the Management of Chordomas
of the Spine and Sacrum (Yamada et al)• 24 pts (21 1º tumors) rx’ed with single-fraction SRS
– Median follow-up 24 months
• SRS was administered as definitive (10), neoadjuvant (6) or adjuvant (8) treatment
• 95% control rate-High rates of LC in 1º chordomas– Radical surg, surg (en bloc) + high dose RT, definitive RT+/- TKI
• Limited toxicity (to date)– 1 sciatic neuropathy -1 vocal cord paralysis
• Will need longer follow-up on this regimen– Neuropathies are late events→H. Suit: “Late events occur late”– How to do phase 1 studies in Radiation Oncology- ? Surrogate endpoints?
IG-SRS for Spine Sarcoma(Folkert et al, MSKCC)• Conventional RT of spine sarcomas: prolonged RT course
– Conventional doses ~ 50 Gy not effective– High doses ~ 70-77 Gy by sophisticated techniques/particles
effective for 1º tumors->~85% LC– Hypofx and single-fx image-guided stereotactic RT (IG-SRS)
may be more convenient/cost effective Rx– 33% pts 1º and 66% pts met tumors Rx’ed since 2005– Myelogram-CT simulation and inverse RT planning
• Image-guided Rx: KV imaging/cone-beam CT scan.– 117 patients/147 lesions Rx’ed with hypofx (3-6 fx; n=49,
33.3%) or single-fx IG-SRS (n=98, 66.7%)• 88% local control with single-fraction IG-SRS.
– A Phase II clinical trial is being developed to use single-fx IG-SRS in the definitive management of sarcoma.
• Exercise caution for 1º tumor pts at risk for late effects
Outcomes, IG-SRS
24 months
Local Progression-Free Survival (LPFS)
Full Cohort82.6%
(95% CI 74.4-90.8%)
Metastatic lesions80.6%
(95% CI 70.6-90.6%)
Primary lesions88%
(95% CI 74.6-100%)
Hypofractionated IG-SRS
68.2% (95% CI 47.8-88.6%)
Single-fraction IG-SRS
88.2% (95% CI 80.2-96.2%)
Overall Survival (OS)
Full Cohort51%
(95% CI 40.6-61.4%)
Metastatic patients39%
(95% CI 26.6-51.4%)
Primary patients77.1%
(95% CI 61.7-92.5%)
Hypofractionated IG-SRS patients
42.7% (95% CI 23.1-62.3%)
Single fraction IG-SRS patients
54.4% (95% CI 42-66.8%)
Local progression-free survival and overall survival, full cohort.
Local progression-free survival and overall survival, lesions
treated with single-fraction and hypofractionated IG-SRS
P=.005
P=.020
24Gy x1
Single
Hypo
Hypo
Multivariate analysis: single-fraction IG-SRS retained its significance in terms of reduction in local recurrence (P=.002): HR 0.251 (95% CI: 0.103-0.612).