Improvement of Local Control in Skull Base, Spine and Sacral Chordomas Treated by Surgery and Protontherapy Targeting Hypoxic Cells Revealed by [18F]FAZA) PET/CT Tracers

Study Overview
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Brief Summary
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Improved local control of chordoma initially treated with surgery or not, thanks to adjuvant radiotherapy oriented by conventional imaging Computed Tomography /Magnetic Resonance Imaging (CT / MRI) and guided by the [18Fluor] ([18F]) Fluoroazomycin Arabinofuranoside (FAZA) Positron Emission Tomography / Computed Tomography (PET / CT) to target the radioresistant hypoxic cells.

Detailed Description
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Due to the close contacts of the lesion with the neurovascular structures, in the case of skull base chordoma and mobile spine, surgery is often incomplete. On the contrary, surgery of the sacral region (for which the block excision is often possible) brings a better therapeutic outcome. Radiotherapy with high-dose supplement improves the outcomes for all these lesions. Intratumoral hypoxia is a primary factor of radioresistance, it's known since long by radiation oncologists. [18F]FAZA gives an image of the hypoxic volume target. Investigators propose to increase the radioactive dose in the hypoxic volume target but in order to succeed, radiation oncologists have to precisely identify this hypoxic volume. Radiation oncologists would increase of 10% the radioactive dose that will allow us to improve local control at 3 years of 15% without any additional side effect.

Official Title
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Improvement of Local Control in Skull Base, Spine and Sacral Chordomas Treated by Surgery and Protontherapy Targeting Hypoxic Cells Revealed by [18F]FAZA) PET/CT Tracers

Conditions
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Skull Base Chordoma, Vertebral Chordoma

Intervention / Treatment
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* Procedure: Surgery
* Radiation: Protontherapy
* Drug: 18F FAZA


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Typical chordoma and chondroid chordoma of the skull base, spine or chordoma of sacral region Patient undergoing an additional or exclusive radiotherapy (Photontherapy and/or Prothontherapy) Age ≥ 18 years old ECOG performance status 0 to 2 Satisfying biological functions 28 days before inclusion : Haemoglobin ≥ 9 g/dL Neutrophils ≥ 1500/mm3 Platelets ≥ 100 000/mm3 ASAT, ALAT, GGT, PAL ≤ 1.5 N, bilirubin ≤ 40 μmol/L, LDH ≤ 1.5 N Creatininemia < 1.5 N Satisfying vital cardiac and respiratory functions Neurologic functions well stabilised Effective contraception for women of childbearing age during the the protontherapy treatment and during the month following the end of treatment. A pregnancy test shall be negative at inclusion. Patient covered by health insurance Patient provided with information and signature of informed consent. Exclusion Criteria: Dedifferentiated chordomas, chondrosarcoma History of cancer (except cutaneous basocellular epithelioma or epithelioma of the uterine cervix) having recurred in the 5 years preceding entry in the trial and no relapse in the last 3 years Metastatic patient History of brain radiation therapy, or base of the skull or spinal segments to be treated Contraindications to radiotherapy Contraindications to PET/CT examinations [18F] Fluorodexoxyglucose (FDG) and [18]FAZA Associated pathology likely to prevent the patient from receiving treatment, Incompatible treatment with the inclusion in the study (oxygen therapy, EPO, anti-vascular treatments, anti-angiogenic treatments) Patient already included in another therapeutic trial with an experimental medication, Patient currently nursing, Persons deprived of their liberty, or under guardianship, Impossibility of undergoing the trial's medical follow-up for geographical, social or psychological reasons.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: [18F]FAZA PET/CT<br>In residual chordoma tumors after surgery, Investigators propose a protontherapy guided by conventional imaging (CT/MRI) and a boost guided by FAZA PET/CT, in order to target the hypoxic zones and to increase the dose in an adequate manner, which could result in improving long-term local control and reducing complications. | Procedure: Surgery<br>* The operative approach and operating time will be performed according to neurosurgical practices (for head and neck) or surgical orthopaedic team (for sacrum) depending on the location, the extension and the relationship of the lesion to critical structures. The surgery can be macroscopically complete or incomplete.<br>Radiation: Protontherapy<br>* Radiotherapy will be done with the Cyclotron, for a total dose of 78 Gray Relative Biological Effective (Gy RBE) - 70 Gy RBE to the tumor bed and macroscopic volume and 8 Gy RBE to the the hypoxic component volume, delivered in 39 fractions spread over 67 days.<br>Drug: 18F FAZA<br>* FAZA PET/CT, in order to target the hypoxic zones<br>* Other names: 18F FLUOROAZOMYCIN-ARABINOFURANOSIDE;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement local control of chordomas according to RECIST criteria. | Rate of local control at 3 years | 36 months | 
| Improvement local control of chordomas according to PERCIST criteria | Rate of local control at 3 years | 36 months |