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Rarer Bone Tumors

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

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Rarer Bone Tumors

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  1. Rarer Bone Tumors Thomas F. DeLaney, M.D. Co-Director: Sarcoma Program Medical Director: F. H. Burr Proton Center Massachusetts General Hospital

  2. 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 1 ,8 ,6 ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months Survival-Advanced InoperableChondrosarcoma (Picci et al)

  3. OS and stage of inoperable disease 1 local only local + lung ,8 lung only multiple sites ,6 Cum. Survival ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months P-Value 0.0049

  4. 1 ,8 ,6 Cum. Survival ,4 ,2 Cum. Survival (YES) Cum. Survival (NO) 0 0 12 24 36 48 60 72 84 96 108 120 months 1 ,8 ,6 Cum. Survival ,4 Cum. Survival (YES) ,2 Cum. Survival (NO) 0 0 12 24 36 48 60 months OS and Medical Treatment (all pts) P-Value 0.0487 Pts with metastasis only (local & local + met excluded) P-Value 0.0082

  5. 1 ,8 ,6 ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months 1 ,8 ,6 ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months OS and Radiotherapy (all pts) OS and Radiotherapy (Local + met) P-Value 0.1052 P-Value 0.1063 Cum. Survival (YES) Cum. Survival (YES) Cum. Survival (NO) Cum. Survival (NO) OS and Radiotherapy (Local only) P-Value 0.0032 1 ,8 ,6 Cum. Survival ,4 ,2 Cum. Survival (YES) Cum. Survival (NO) 0 0 12 24 36 48 60 72 84 96 108 120 months

  6. High-Dose Single-Fraction RTfor the Management of Chordomasof 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?

  7. 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

  8. Outcomes, IG-SRS Single P=.005 Hypo P=.020 24Gy x1 Hypo Local progression-free survival and overall survival, lesions treated with single-fraction and hypofractionated IG-SRS Local progression-free survival and overall survival, full cohort. 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).

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