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. 2023 Dec 1;15(23):5687.
doi: 10.3390/cancers15235687.

Risk Factors for Radiation Necrosis and Local Recurrence after Proton Beam Therapy for Skull Base Chordoma or Chondrosarcoma

Mizuki Takahashi  1 , Masashi Mizumoto  1 , Yoshiko Oshiro  2 , Hiroyoshi Kino  3 , Hiroyoshi Akutsu  4 , Kei Nakai  1 , Taisuke Sumiya  1 , Eiichi Ishikawa  3 , Kazushi Maruo  5 , Hideyuki Sakurai  1
Affiliations

Risk Factors for Radiation Necrosis and Local Recurrence after Proton Beam Therapy for Skull Base Chordoma or Chondrosarcoma

Mizuki Takahashi et al. Cancers (Basel). .

Abstract

[Proposal] Here, we retrospectively evaluate risk factors for radiation necrosis and local recurrence after PBT for skull base chordoma or chondrosarcoma. [Patients and Methods] We analyzed 101 patients who received PBT for skull base chordomas and chondrosarcomas from January 1989 to February 2021. Multivariable logistic regression models were applied for local recurrence, temporal lobe radiation necrosis rates, and temporal lobe radiation necrosis. [Results] In multivariate analysis, chordoma and large tumor size were independent significant factors for local recurrence. The 1-, 2-, 3-, 4- and 5-year local recurrence rates were 3.9%, 16.9%, 20.3%, 28.5% and 44.0% for chordoma and 0%, 0%, 0%, 0% and 7.1% for chondrosarcoma, respectively. The local recurrence rates of small tumors (<30 mm) were 4.3%, 14.7%, 17.7%, 17.7% and 25.9%, and those for large tumors were 3.6%, 15.1%, 19.2%, 32.7% and 59.6%, respectively. In multivariate analysis, BED Gy10 and total dose were risk factors for radiation necrosis. [Conclusions] For skull base chordoma and chondrosarcoma, the risk factors of local recurrence were chordoma and large tumor size, and those of radiation necrosis were BED Gy10 and total dose, respectively. DVH analysis is needed to investigate the risk factors for brain necrosis in more detail.

Keywords: brain necrosis; chondrosarcoma; chordoma; proton beam therapy; radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Local recurrence rate in all patients. (b) Local recurrence rates for cases of chordoma and chondrosarcoma.
Figure 1
Figure 1
(a) Local recurrence rate in all patients. (b) Local recurrence rates for cases of chordoma and chondrosarcoma.
Figure 2
Figure 2
Rate of temporal lobe radiation necrosis in all patients.
Figure 3
Figure 3
A case of temporal lobe radiation necrosis. (a) A tumor was found in contact with the left temporal lobe (white circle). (b) The tumor was grossly excised (white circle). (c) Irradiated field 0 to 39.2 Gy(RBE) in 28 fr (twice per day) including the tumor bed and surgical pathway. Dose distribution. The isodose lines represent 100–10% of the prescription dose from inside to outside. (d) Irradiated field 40.6 to 58.8 Gy(RBE) in 42 fr (twice per day) including the tumor bed and surgical pathway with a minimized radiation dose to the optic nerve, optic chiasm, temporal lobe, retina and brainstem. (e) Irradiated field 60.2 to 78.4 Gy(RBE) in 56 fr (twice per day) with a minimized radiation dose to the optic nerve, optic chiasm, temporal lobe, retina and brainstem. The maximum dose to the retina is 50 Gy(RBE), that to the optic nerve and chiasm is 54 Gy(RBE) and that to the brainstem and temporal lobe is 60 Gy(RBE). (f) At 44 months after proton beam therapy, contrast-enhanced MRI showed a small contrast-enhanced lesion in the left medial temporal lobe (white arrow). This spot was included in the irradiated area at boost. (g) There was mild edema around the contrast-enhanced lesion (white arrow).
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