Advances in Radiation Oncology (May 2024)

A Prospective Phase I/II Clinical Trial of High-Dose Proton Therapy for Chordomas and Chondrosarcomas

  • Sana S. Dastgheyb, MD, PhD,
  • Alexandra D. Dreyfuss, MD,
  • Michael J. LaRiviere, MD,
  • Jahan J. Mohiuddin, MD,
  • Brian C. Baumann, MD,
  • Jacob Shabason, MD,
  • Robert A. Lustig, MD,
  • Jay F. Dorsey, MD, PhD,
  • Alexander Lin, MD,
  • Sean M. Grady, MD,
  • Bert W. O'Malley, MD,
  • John Y.K. Lee, MD,
  • Jason G. Newman, MD,
  • James M. Schuster, MD,
  • Michelle Alonso-Basanta, MD, PhD

Journal volume & issue
Vol. 9, no. 5
p. 101456

Abstract

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Purpose: The purpose of this study was to evaluate the feasibility and safety of dose-escalated proton beam therapy for treating chordomas and chondrosarcomas of the skull base and spine. Methods: A prospective cohort of 54 patients (42 with chordomas and 12 with chondrosarcomas) was enrolled between 2010 and 2018. The primary endpoints were feasibility and 5 days, none for toxicities related to treatment. There were no grade 4 acute toxicities and 1 grade 3 acute toxicity (sensory neuropathy). The only 2 grade 3 late toxicities recorded, osteoradionecrosis and intranasal carotid blowout (mild and not emergently treated), occurred in a single patient. We report overall survival as 83% at 5 years, with local failure-free survival and progression-free survival rates of 72% and 68%, respectively. Five patients developed distant disease, and among the 9/54 patients who died, 4 deaths were not attributed to treatment or recurrence. Conclusions: Our findings suggest that high-dose proton therapy alone or in combination with IMRT is a safe and effective treatment option for chordomas and chondrosarcomas of the skull base and spine.