Carbon Ion Radiotherapy for Chordomas and Low-Grade Chondrosarcomas of the Skull Base

Schulz-Ertner, Daniela; Nikoghosyan, Anna; Thilmann, Christoph; Haberer, T.; Jäkel, Oliver; Karger, Christian P.; Scholz, M.; Kraft, Gerhard; Wannenmacher, M; Debus, Jürgen

doi:10.1007/s00066-003-1120-2

Cited by 94 publications

(43 citation statements)

References 33 publications

(39 reference statements)

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“…32,33 The prescribed median tumor dose was 60 GyE. Actuarial 3-year local control rates were 100% for chondrosarcomas and 81% for chordomas, which appear comparable to the published results with protons.…”

Section: Sarcomas Of the Base Of Skullsupporting

confidence: 73%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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Several model studies have shown potential clinical advantages with charged particles (protons and light ions) compared with 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in many disease sites. The newly developed intensity-modulated proton therapy (IMPT) often yields superior dose distributions to photon IMRT, with the added advantage of a significant reduction in the volume of healthy normal tissues exposed to low-to-medium doses. Initially, the major emphasis in clinical research for proton and light ion therapy was dose escalation for inherently radioresistant tumors, or for lesions adjacent to critical normal structures that constrained the dose that could be safely delivered with conventional x-ray therapy. Since the advent of IMRT the interest in particle therapy has gradually shifted toward protocols aimed at morbidity reduction. Lately the emphasis has mostly been placed on the potential for reduced risk of radiation-induced carcinogenesis with protons. Compared with 3D-CRT, a 2-fold increase has been theoretically estimated with the use of IMRT due to the larger integral volumes. In the pediatric setting, due to a higher inherent susceptibility of tissues, the risk could be significant, and the benefits of protons have been strongly emphasized in the literature. There is a significant expansion of particle therapy facilities around the world. Increasing public awareness of the potential benefits of particle therapy and wider accessibility for patients require that treating physicians stay abreast of the clinical indications of this radiotherapy modality. The article reviews the available literature for various disease sites in which particle therapy has traditionally been considered to offer clinical advantages and to highlight current lines of clinical research. The issue of radiation-induced second malignancies is examined in the light of the controversial epidemiological evidence available. The cost-effectiveness of particle therapy is also discussed. Cancer 2007;109: 1227-38. 2007 American Cancer Society.KEYWORDS: radiotherapy, proton therapy, light ions, intensity modulated radiotherapy, second cancers. C harged particles (protons and light ions) have a finite range in tissues. The interaction probability to cause ionization increases as they lose velocity traversing through tissues, so that a peak of dose occurs at a depth proportional to the energy of each particle. Beyond this peak no further dose deposition occurs. This phenomenon was described by William Bragg over 100 years ago.1 The dose peak may be 'spread out' to achieve a plateau of uniform dose to precisely cover the target while sparing adjacent normal structures. Passively scattered beams of a certain aperture can be produced by means of range-shifting modulators of variable thickness providing spread-out Bragg peaks (SOBP) for clinical use. The recent introduction of the spot scanning method represents a major advance in particle therapy.2 In this method, small pencil beams of a certain

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Section: Sarcomas Of the Base Of Skullsupporting

confidence: 73%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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“…[15][16][17][18][19] Various prognostic factors, including but not limited to sex, [20][21][22][23] age, 15,16 and tumor volume, 16,22,[24][25][26] have been identified for this neoplasm, but the clinical significance remains questionable, because these findings are not consistent. For instance, female sex has been suggested as a negative prognostic feature in some but not all studies.…”

Section: Introductionmentioning

confidence: 99%

Incidence and relative survival of chordomas

Smoll

Gautschi

Radovanović

et al. 2013

Cancer

167

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BACKGROUND: Chordomas are rare bone tumors arising from remnants of the embryonic notochord. METHODS: Data for this study were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute to calculate the incidence, relative survival (RS), and standardized mortality ratio (SMR) of patients diagnosed with intracranial and extracranial chordomas and to assess the effects of age and sex on this disease. RESULTS: The overall incidence of extracranial and intracranial chordomas was 8.4 per 10 million population. The median overall survival of patients with chordoma patients was 7.7 years. The median survival was 7.7 years for male patients and 7.8 years for female patients. Younger patients (aged <40 years) survived longer compared with older patients (10-year RS, 68% vs 43%). The estimated age-standardized 5-year, 10-year, and 20-year RS rates was 72%, 48%, and 31%, respectively. The SMR in the overall cohort was 4.6 (95% confidence interval, 4.22-5.0) or 21.0 (95% confidence interval, 16.6-27.2) in young adult patients and 3.0 (95% confidence interval, 2.6-3.4) in elderly patients. CONCLUSIONS: The elderly had a more aggressive form of this disease; and, other than the incidence, sex did not influence outcome in this disease. The study of chordomas presents a good case for the contribution that the SMR can have on measuring the impact of a disease on a population of patients. Although the younger population has better survival rates, the impact (SMR) in the younger age groups is much higher than in older populations.

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“…The vertebra had been removed and titanium implanted for mechanical stabilization. Chordomas are characterized by high rates of local failure, even if treated with 60 Gy (photons), or the corresponding equivalence dose ( 60 Co Gy equivalents [CGE]) using charged particles [2,3,7,8,13,14,17,20,21]. In PT, the dose is prescribed in CGE, based on a conversion by 1.1 of physical proton dose to account for enhanced biological effectiveness of protons versus photons [15].…”

Section: Introductionmentioning

confidence: 99%

Donut-Shaped High-Dose Configuration for Proton Beam Radiation Therapy

Rutz

Lomax

2005

Strahlenther Onkol

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Background:The authors report on the conception and first clinical application of a donut-shaped high-dose configuration for proton therapy (PT). This approach allows one to intensify target volume dose coverage for targets encompassing a critical, dose-limiting structure -like here, the cauda equina -, whilst delivering minimal dose to other healthy structures surrounding the target, thereby reducing the integral dose. Methods and Results: Intensity-modulated PT methods (IMPT) for spot scanning were applied to create and deliver a donutshaped high-dose configuration with protons, allowing treating > 75% of the target with at least 95% of the prescribed dose of 72.8 CGE, whilst restricting dose to the cauda equina to 60-65 CGE. Integral dose was lower by a factor of 3.3 as compared to intensity-modulated radiotherapy with photons (IMXT). Conclusion: IMPT and spot scanning technology allow a potentially clinically useful approach which is also applicable to spare other critical structures passing through a target volume, including spinal cord, optic nerves, chiasm, brain stem, or urethra.

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Carbon Ion Radiotherapy for Chordomas and Low-Grade Chondrosarcomas of the Skull Base

Cited by 94 publications

References 33 publications

Current status of radiotherapy with proton and light ion beams

Current status of radiotherapy with proton and light ion beams

Incidence and relative survival of chordomas

Donut-Shaped High-Dose Configuration for Proton Beam Radiation Therapy

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