Particle therapy using carbon ions or protons as a definitive therapy for patients with primary sacral chordoma

Mima, Masayuki; Demizu, Yusuke; Jin, Dongcun; Hashimoto, Naoki; Takagi, Masaru; Terashima, Kazuki; Fujii, Osamu; Niwa, Yasue; Akagi, Takashi; Daimon, Takashi; Hishikawa, Yoshio; Abe, Mitsuyuki; Murakami, Masao; Sasaki, Ryohei; Fuwa, Nobukazu

doi:10.1259/bjr.20130512

Cited by 64 publications

(69 citation statements)

References 43 publications

(88 reference statements)

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“…1 Surgical resection of spinal and sacral chordoma remains the standard for control of macroscopic disease; however, it is associated with significant morbidity and reduction in ambulation, which could have significant repercussions for patients. 2 Surgical margins are defined according to the Enneking classification system as intralesional, marginal, wide, and radical.…”

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confidence: 99%

Safety and Local Control of Radiation Therapy for Chordoma of the Spine and Sacrum

Pennicooke

Laufer

Sahgal

et al. 2016

Spine

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Study Design Systematic literature review. Objective To assess the toxicity, common radiation doses, and local control (LC) rates of radiation therapy for chordoma of the spine and sacrum and identify the difference in LC and toxicity between adjuvant, salvage, and primary therapy using radiation. Summary of Background Data Chordoma of the spine is typically a low-grade malignant tumor thought to be relatively radioresistant with a high rate of local recurrence and the potential for metastases. Improved results of modern radiation therapy in the treatment of chordoma support exploration of its role in the management of primary/de novo chordoma or recurrent chordoma. Methods We conducted a systematic literature review using PubMed and Embase databases to assess information available regarding the toxicity, LC rates, and overall survival (OS) rates for adjuvant, salvage, and primary radiation therapy for spinal and sacral chordoma. Results A total of 40 articles were reviewed. Evidence quality was low or very low. The highest rates of LC and OS were with early adjuvant RT for primary/de novo disease. Salvage RT for recurrent disease has very small cohorts and thus strong conclusions were not able be made. Conclusion The use of pre- and/or post-operative photon image-guided radiotherapy (IGRT), proton or carbon ion therapy should be considered for patients undergoing surgery for the treatment of primary and recurrent chordomas in the mobile spine and sacrum, since these RT modalities may improve local control. Preoperative evaluation by the surgeon and radiation oncologist should be used to formulate a cohesive treatment plan. The use of photon IGRT or carbon ion therapy as the primary treatment of chordoma, when currently in its developmental stage, shows promise and requires clear delineation of toxicity profile and long-term local control.

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confidence: 99%

Safety and Local Control of Radiation Therapy for Chordoma of the Spine and Sacrum

Pennicooke

Laufer

Sahgal

et al. 2016

Spine

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“…In cases of adjuvant radiotherapy, their proximity to critical structures adds another layer of complexity to management by limiting the safe dose of radiotherapy. Therefore, high‐dose proton or carbon ion therapy is preferred to conventional radiotherapy . The prognosis depends on the completeness of surgical excision, with a reported 10‐year survival rate of 40% .…”

Section: Discussionmentioning

confidence: 99%

A Rare Cause of Cauda Equina Syndrome by Infiltration: Case of a Sacral Chordoma

Ramdass

Brennan

2015

J American Geriatrics Society

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inversion recovery, and DWI sequences). The pulvinar sign is suggestive of variant CJD. 3 DWI has been shown to be the most sensitive MR sequence. 4,5 DW-MRI may show CJD-associated lesions 3 weeks after symptoms with high sensitivity (91%) and specificity (95%), 5,6 although studies suggest that up to 80% of these abnormalities are missed, 3 like in the current case, despite previous MRI, illustrating that awareness of MRI features of CJD is insufficient.In the current case, all other complementary investigations were inconclusive. EEG can show polymorphic and repetitive slower wave discharges, characteristic bi-or triphasic paroxysmal waves, or spike-slow waves in 60% of cases, 7 but these abnormalities occur intermittently, and sensitivity of EEG periodic sharp wave complexes is only 66% with 74% specificity. 8 With 88% sensitivity and 72% specificity, a negative CSF 14-3-3 assay does not exclude CJD, depending on of the evolution of the disease and disease subtype. 9,10 Several biomarkers, including tau protein, neurospecific enolase, and S100b protein, have attracted great interest. CSF tau protein had better diagnostic accuracy than other protein detection, with 91% sensitivity and 88% specificity. 9 In the current case, a search for prion protein gene mutation was performed for several reasons. Two of the woman's children were alive, family history was missing, and clinical signs and course of the genetic form of the disease are usually comparable with those of the sporadic form.Geriatricians should recognize clinical and paraclinical signs of CJD, but diagnosis remains challenging. The clinical presentation can mimic dementia or stroke, but MRI, EEG, and biomarkers can assist in the diagnosis. According to international criteria, this woman had probable CJD, but no autopsy was performed.

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“…Currently, there is a growing body of work that supports the use of high-dose radiation in cases where the morbidity of surgery is unsafe given the patient's medical condition or unacceptable to the patient [3,8,9]. However, we do not know with certainty which tumors are best suited for definitive radiation.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

“…More recently, some centers have reported effective local control of sacral chordomas using high-dose proton or carbon-ion-based radiation without surgery [2,8,9]. The impact of high-dose radiation on the function of sacral nerve roots has not been well documented.…”

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confidence: 99%

CORR Insights®: What are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients with Sacral Chordoma?

Schwab

2017

Clinical Orthopaedics &Amp; Related Research

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Particle therapy using carbon ions or protons as a definitive therapy for patients with primary sacral chordoma

Abstract: Terashima K, et al. Particle therapy using carbon ions or protons as a definitive therapy for patients with primary sacral chordoma. Br

Cited by 64 publications

References 43 publications

Safety and Local Control of Radiation Therapy for Chordoma of the Spine and Sacrum

Safety and Local Control of Radiation Therapy for Chordoma of the Spine and Sacrum

A Rare Cause of Cauda Equina Syndrome by Infiltration: Case of a Sacral Chordoma

CORR Insights®: What are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients with Sacral Chordoma?

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