Treatment of Chordomas With Cyberknife

Henderson, Fraser; McCool, Kyle; Seigle, Juliet; Jean, Walter C.; Harter, William K.; Gagnon, Gregory

doi:10.1227/01.neu.0000341166.09107.47

Cited by 86 publications

(42 citation statements)

References 40 publications

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“…Interestingly, little literature is available on the α/β ratio or SF2 on chordomas (α/β ratio: ~2.45), chondrosarcomas or adenoid cystic carcinomas, however, these malignancies are some of the primary malignancies treated with carbon ions in a study that was terminated at GSI [25,26]. Presumably, these tumors were chosen because of a high local failure rate when given photon irradiation.…”

Section: Towards the Establishment Of A National Ion Therapy Randd Centermentioning

confidence: 99%

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context

et al. 2014

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Radiotherapy for the treatment of cancer is undergoing an evolution, shifting to the use of heavier ion species. For a plethora of malignancies, current radiotherapy using photons or protons yields marginal benefits in local control and survival. One hypothesis is that these malignancies have acquired, or are inherently radioresistant to low LET radiation. In the last decade, carbon ion radiotherapy facilities have slowly been constructed in Europe and Asia, demonstrating favorable results for many of the malignancies that do poorly with conventional radiotherapy. However, from a radiobiological perspective, much of how this modality works in overcoming radioresistance, and extending local control and survival are not yet fully understood. In this review, we will explain from a radiobiological perspective how carbon ion radiotherapy can overcome the classical and recently postulated contributors of radioresistance (α/β ratio, hypoxia, cell proliferation, the tumor microenvironment and metabolism, and cancer stem cells). Furthermore, we will make recommendations on the important factors to consider, such as anatomical location, in the future design and implementation of clinical trials. With the existing data available we believe that the expansion of carbon ion facilities into the United States is warranted.

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Section: Towards the Establishment Of A National Ion Therapy Randd Centermentioning

confidence: 99%

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context

et al. 2014

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“…Chordomas represent only 1 to 4% of all primary malignant tumors and among their hallmark characteristics are containment and slower growth kinetics together with less frequent metastases [12]. While the first-line therapy of choice for chordoma treatment remains surgery, radiation therapy is also used [4,13,14] because of the deeply ensconced anatomical location of these tumors and the severe negative quality of life issues resulting from surgical resections [6]. Radiation therapy, especially in the case of charged particle beams involving carbon ions or protons, has been commanding much attention of late particularly in the treatment of bone and soft tissue sarcomas [6,15].…”

Section: Introductionmentioning

confidence: 99%

Comparison of human chordoma cell-kill for 290 MeV/n carbon ions versus 70 MeV protons in vitro

Fujisawa

Genik

Kitamura³

et al. 2013

Radiat Oncol

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BackgroundWhile the pace of commissioning of new charged particle radiation therapy facilities is accelerating worldwide, biological data pertaining to chordomas, theoretically and clinically optimally suited targets for particle radiotherapy, are still lacking. In spite of the numerous clinical reports of successful treatment of these malignancies with this modality, the characterization of this malignancy remains hampered by its characteristic slow cell growth, particularly in vitro.MethodsCellular lethality of U-CH1-N cells in response to different qualities of radiation was compared with immediate plating after radiation or as previously reported using the multilayered OptiCell™ system. The OptiCell™ system was used to evaluate cellular lethality over a broad dose-depth deposition range of particle radiation to anatomically mimic the clinical setting. Cells were irradiated with either 290 MeV/n accelerated carbon ions or 70 MeV accelerated protons and photons and evaluated through colony formation assays at a single position or at each depth, depending on the system.ResultsThere was a cell killing of approximately 20–40% for all radiation qualities in the OptiCell™ system in which chordoma cells are herein described as more radiation sensitive than regular colony formation assay. The relative biological effectiveness values were, however, similar in both in vitro systems for any given radiation quality. Relative biological effectiveness values of proton was 0.89, of 13–20 keV/μm carbon ions was 0.85, of 20–30 keV/μm carbon ions was 1.27, and >30 keV/μm carbon ions was 1.69. Carbon-ions killed cells depending on both the dose and the LET, while protons depended on the dose alone in the condition of our study. This is the first report and characterization of a direct comparison between the effects of charged particle carbon ions versus protons for a chordoma cell line in vitro. Our results support a potentially superior therapeutic value of carbon particle irradiation in chordoma patients.ConclusionCarbon ion therapy may have an advantage for chordoma radiotherapy because of higher cell-killing effect with high LET doses from biological observation in this study.

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“…With regard to fractionated stereotactic approaches such as CyberKnife, retrospective studies have reported similar results. One study of 18 chordoma patients reported an OS of 74% and local control of 59% at 5 years (32), while another study of 20 chordoma patients demonstrated an OS of 53% at 5 years (33). Our outcomes are consistent, and perhaps superior to these results, as we found 94.12% OS and 91.67% LRFS at 3 years following initial surgery.…”

Section: Discussionmentioning

confidence: 99%

Management of Chordoma and Chondrosarcoma with Fractionated Stereotactic Radiotherapy

et al. 2017

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ObjectiveTo evaluate the efficacy and toxicity of fractionated stereotactic radiotherapy (FSRT) for chordoma and chondrosarcoma.MethodsTwenty consecutive patients with a histopathologic diagnosis of chordoma (n = 16) or chondrosarcoma (n = 4) treated between 2010 and 2016 were retrospectively identified. All patients underwent FSRT in five fractions to a median dose of 37.5 Gy (range: 25–40 Gy) and followed with serial magnetic resonance imaging. Overall survival (OS), local recurrence-free survival (LRFS), and event-free survival (EFS) were estimated using the Kaplan–Meier method.ResultsWith a median follow-up of 28 months after FSRT and 40 months after initial surgery, crude OS and LRFS were 90%. Nine patients (45%) reported grade 1–3 acute toxicity, and two patients (10%) experienced grade 4, 5 late toxicity. One patient previously treated with proton therapy died from radiation vasculopathy 9 months after FSRT. The use of FSRT for recurrent disease or in patients with prior radiation therapy was associated with significantly decreased EFS.ConclusionFSRT for chordoma and chondrosarcoma is associated with high rates of OS and local control. Although many patients experience acute toxicity, there is a low incidence of late toxicity or irreversible treatment related morbidity despite the frequency of prior radiotherapy in this population. FSRT is an effective adjuvant or salvage treatment for chordoma and chondrosarcoma.

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Treatment of Chordomas With Cyberknife

Cited by 86 publications

References 40 publications

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context

Comparison of human chordoma cell-kill for 290 MeV/n carbon ions versus 70 MeV protons in vitro

Management of Chordoma and Chondrosarcoma with Fractionated Stereotactic Radiotherapy

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