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

Adron therapy in the treatment of chordoma of the spinal axis: a systematic review

Meeting Abstract

  • D. Amelio - Section of Medicine, AtreP- Agenzia Provinciale per la Protonterapia, Trento, Italy
  • M. Cianchetti - Section of Medicine, AtreP- Agenzia Provinciale per la Protonterapia, Trento, Italy
  • B. Rombi - Section of Medicine, AtreP- Agenzia Provinciale per la Protonterapia, Trento, Italy
  • M. Amichetti - Section of Medicine, AtreP- Agenzia Provinciale per la Protonterapia, Trento, Italy

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog008

DOI: 10.3205/09ptcog008, URN: urn:nbn:de:0183-09ptcog0089

Published: September 24, 2009

© 2009 Amelio et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: Chordoma is a rare neoplasm mainly involving the spinal axis. Radical excision of operable lesions may be curative and to date represents the mainstay of treatment. Unfortunately, the extent of resection directly correlates with possible resulting functional deficits. Moreover, radical surgery of spinal lesions is difficult to achieve mainly due to the anatomical characteristics of spinal column. Many of these patients are referred for radiotherapy but its role is still debated.

Material and methods: A systematic review of the scientific literature regarding the irradiation of chordomas of the spine was managed in order to assess the role played by adron therapy (ions and protons) in comparison with conventional and advanced techniques of photon beam therapy. By applying a strict series of inclusion criteria, two independent reviewers selected from the PubMed database all the studies available until April 2009 in which a minimum of 10 patients received irradiation for spinal chordoma.

Results: According to the inclusion criteria, 17 articles were included in the analysis. There were no prospective trials (randomized or nonrandomized), providing clinical outcomes for a total 376 patients scattered in many years. Eight studies reported on conventional photon beam therapy in 144 patients with a follow-up range of 1–20 years. The total delivered doses ranged between 25 and 76 Gray (Gy). The 5 and 10 years local control (LC) rate ranged between 55–77% and 24–77%, respectively. The 5 and 10 years overall survival (OS) rate varied between 44–-87.8% and 17–50%, respectively. Thirty three percent of patients underwent radical excision. The patients treated by adron therapy were 221 scattered in 8 reports with a follow-up ranging from 2 months to 21.7 years. Radical surgery was carried out in 12% of cases. The total delivered doses ranged between 29 and 83 Gy-equivalent achieving a 5 and 10 years LC rate varying between 33–96% and 48–57.5%, respectively. The 5 and 10 years OS ranged between 50–85% and 22–62.5%, respectively. Only one report relating to fractionated stereotactic radiotherapy was found: 11 patients were treated in a 5 fractions schedule with doses ranging between 24 and 40 Gy. With a median follow-up of 3.8 years a 5 year LC and OS of 59.1% and 74.3%, respectively, were recorded.

Conclusion: The administration of adjuvant high dose radiation therapy following non radical surgery in spinal axis chordoma offers comparable results in terms of LC and OS to radical excision. The use of adron therapy improves the capability of delivering higher dose levels (>70 Gy) without increasing the risk of significant sequelae.