Эффективность и безопасность протонной терапии при хордомах и хондросаркомах основания черепа: анализ трехлетних результатов

Alyona Alekseevna Lemaeva; Igor  Aleksandrovich Gulidov; Kira Evgenevna Medvedeva; Sergey Anatolevich Ivanov; Andrey Dmitrievich Kaprin

doi:10.37469/0507-3758-2025-71-5-OF-2426

Vol. 71 No. 5 (2025), ORIGINAL ARTICLES. CLINICAL RESEARCH

Vol. 71 No. 5 (2025)

Efficacy and Safety of Proton Therapy for Skull Base Chordomas and Chondrosarcomas: An Analysis of Three-Year Outcomes

ORIGINAL ARTICLES. CLINICAL RESEARCH

https://doi.org/10.37469/0507-3758-2025-71-5-OF-2426

Published 05.11.2025

Alyona Alekseevna Lemaeva⁺⁻
Igor Aleksandrovich Gulidov⁺⁻
Kira Evgenevna Medvedeva⁺⁻
Sergey Anatolevich Ivanov⁺⁻
Andrey Dmitrievich Kaprin⁺⁻

Alyona Alekseevna Lemaeva

A. Tsyb Medical Radiological Research Centre - branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031, 10, Zhukov St., Obninsk

https://orcid.org/0009-0000-2864-1211

Igor Aleksandrovich Gulidov

A. Tsyb Medical Radiological Research Centre - branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031, 10, Zhukov St., Obninsk

https://orcid.org/0000-0002-2759-297X

Kira Evgenevna Medvedeva

A. Tsyb Medical Radiological Research Centre - branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031, 10, Zhukov St., Obninsk

https://orcid.org/0000-0001-6844-3076

Sergey Anatolevich Ivanov

A. Tsyb Medical Radiological Research Centre - branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031, 10, Zhukov St., Obninsk

https://orcid.org/0000-0001-7689-6032

Andrey Dmitrievich Kaprin

National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation

https://orcid.org/0000-0001-8784-8415

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Keywords

chordoma
chondrosarcoma
skull base
proton therapy

How to Cite

Lemaeva, A. A., Gulidov, I. . A., Medvedeva, K. E., Ivanov, S. A., & Kaprin, A. D. (2025). Efficacy and Safety of Proton Therapy for Skull Base Chordomas and Chondrosarcomas: An Analysis of Three-Year Outcomes. Voprosy Onkologii, 71(5), OF–2426. https://doi.org/10.37469/0507-3758-2025-71-5-OF-2426

Abstract

Introduction. Skull base chordomas and chondrosarcomas are rare, radioresistant tumors characterized by high rates of local recurrence and requiring multidisciplinary management. Scanning beam proton therapy has historically been regarded as the optimal radiation modality for these neoplasms.

Aim. To evaluate the efficacy and safety of scanning beam proton therapy for skull base chordomas and chondrosarcomas.

Materials and Methods. The study included patients with skull base chordomas or chondrosarcomas treated with proton therapy using the Prometheus proton therapy system at the A. Tsyb Medical Radiological Research Center. Treatment plans were developed using ProtomTherapyPlanner software (versions 1.12–2.14) with Monte Carlo algorithm optimization. Outcomes assessed included overall survival, local control, and treatment toxicity. Tumor response was evaluated according to RECIST 1.1 criteria, and toxicity was graded using CTCAE v5.0.

Results. Between 2016 and 2024, 62 patients with chordoma (n = 46) and chondrosarcoma (n = 16) were enrolled. Median follow-up was 3 years. The median gross tumor volume (GTV) was 23 cm³ (IQR 12–39), and the median total radiation dose delivered was 70 GyRBE (range 64–74 GyRBE). Overall survival rates at 1 and 3 years were 98.4 and 94.1 %, respectively. Local control rates were 100 % during the 1st year and 77.9 % during the 3d year. Patients with ECOG performance status 0–1 demonstrated significantly better survival and local control outcomes (p < 0.05). Lower local control rates were observed in non-operated patients and those with tumors adjacent to the brainstem. Severe (grade ≥ 3) radiation complications occurred in 1.6 % of patients.

Conclusion. Scanning beam proton therapy achieved high overall survival and local control rates with minimal toxicity. Optimal outcomes were observed in patients with good performance status (ECOG 0-1) receiving combined modality treatment. Tumor proximity to the brainstem was associated with reduced local control.

https://doi.org/10.37469/0507-3758-2025-71-5-OF-2426

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