gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Definitive high dose photon/proton radiotherapy for unresected chordomas

Meeting Abstract

  • Y.-L. Chen - Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • W. Kobayashi - Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • S. Childs - Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • F. Hornicek - Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
  • A. Rosenberg - Pathology, Massachusetts General Hospital, Boston, USA
  • G. P. Nielsen - Pathology, Massachusetts General Hospital, Boston, USA
  • D. Rosenthal - Diagnostic Radiology, Massachusetts General Hospital, Boston, USA
  • H. Suit - Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • T. DeLaney - Radiation Oncology, Massachusetts General Hospital, Boston, USA

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog040

DOI: 10.3205/09ptcog040, URN: urn:nbn:de:0183-09ptcog0402

Veröffentlicht: 24. September 2009

© 2009 Chen et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objectives: Complete resection +/- adjuvant radiotherapy is the primary treatment for chordomas. However, resection of lumbar or high sacral chordomas may require sacrifice of nerve roots and result in significant loss of neurological function, while some other patients may be medically inoperable or refuse surgery. In these cases, protons may allow conformal delivery of high doses while sparing nearby spinal cord, small bowel, rectum, and other critical organs. We report our experience with definitive proton-based radiotherapy for chordomas.

Methods: 11 patients with spinal chordomas (2 cervical, 1 lumbar, 6 involving up to S2, 2 up to S3) underwent core biopsy (10) or incisional biopsy (1) followed by definitive proton-based radiotherapy from 1997-2008. All patients had newly diagnosed disease at the time of radiotherapy.

Results: Median age was 67 years (30-82). Mean total dose was 77.3 Gy RBE (76.6-77.4 Gy RBE), delivered using primarily protons (mean dose 46.8 Gy RBE ) with a component of 3D conformal or intensity modulated photons (mean dose 30.6 Gy). At mean follow up of 45 months (12–136; mininum 1 year), 10/11 patients had local control. One progressed locally at 2 years. One developed metastatic disease at 1 year and died at 15 months but was locally controlled. There were few late effects; these included moderate fibrosis in the soft tissues overlying the spine in most, incomplete voiding and erectile dysfunction in 1, and sacral insufficiency fracture in another.

Conclusions: High dose proton-based radiotherapy can be an effective definitive treatment for patients with unresected chordomas and offers a chance for preservation of nerve function with minimal side effects.