Effect of Carbon Ion Radiotherapy for Sacral Chordoma: Results of Phase I-II and Phase II Clinical Trials

Imai, Reiko; Kamada, Tadashi; Tsuji, Hiroshi; Sugawara, Shinji; Serizawa, Itsuko; Tsujii, Hirohiko; Tatezaki, Shin-ichiro

doi:10.1016/j.ijrobp.2009.06.048

Cited by 82 publications

(56 citation statements)

References 29 publications

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“…As already mentioned in a previous report, 30 of 38 patients in these clinical trials had no previous surgery [17]. Although the tumours of 26 of these 30 patients were located above the spinal cord level S2, approximately 90% remained ambulatory (with or without canes) almost 5 years after CIRT, and 50% needed no pain medication.…”

Section: Discussionmentioning

confidence: 60%

“…Although the tumours of 26 of these 30 patients were located above the spinal cord level S2, approximately 90% remained ambulatory (with or without canes) almost 5 years after CIRT, and 50% needed no pain medication. No colostomies or urinary diversions were carried out as a consequence of CIRT [17]. Severe sciatic nerve neuropathy was observed in 15 of the 95 patients, which to some extent influenced their quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…Data from 30 patients with sacral chordoma treated with carbon ion radiotherapy were reported in 2004 [16]; a study of a further 38 patients in Phase I/II and II clinical trials observed for almost 5 years was described in 2010 [17]. This work has begun to establish the effectiveness of CIRT for sacral chordoma.…”

Section: Chordomamentioning

confidence: 99%

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Carbon ion radiotherapy for sacral chordoma

Imai¹,

Kamada²,

Sugahara³

et al. 2011

BJR

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ABSTRACT. The National Institute of Radiological Sciences in Chiba, Japan has offered carbon ion radiotherapy (CIRT) since 1994 using carbon ion beams generated by the heavy ion medical accelerator in Chiba (HIMAC). The total number of cases treated with the HIMAC exceeded 5000 in July 2009. Here, we present a retrospective analysis of CIRT for sacral chordoma. The study included 95 patients with medically unresectable sacral chordomas treated between 1996 and 2007. The median age of the patients was 66 years. Of all the patients, 84 had not been treated previously and 11 had a locally recurrent tumour following previous resection. The carbon ion dose ranged from 52.8 to 73.6 GyE (median 70.4 GyE) in a total of 16 fixed fractions over 4 weeks. The median clinical target volume was 370 cm 3 . The overall survival rate at 5 years for all 95 patients was 86%, and follow-up survival time was 42 months (range, 13-112 months). The 5-year local control rate was 88% and median time to local failure was 35 months (range, 13-60 months). Of the 95 patients, 91% remained ambulatory with or without a supportive device. Two patients experienced severe skin or soft tissue complications requiring skin grafts. 15 patients experienced severe sciatic nerve complications requiring continuing medication. CIRT appears effective and safe in the management of patients with sacral chordoma and offers a promising alternative to surgery.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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Carbon ion radiotherapy for sacral chordoma

Imai¹,

Kamada²,

Sugahara³

et al. 2011

BJR

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“…21 Reports of durable tumor control without surgery using high-dose radiation with protons 7 or carbon ions are encouraging. 14 Because various surgical approaches have been used, ranging from intralesional to en bloc, the authors analyzed their influence on LC, particularly in the setting of highdose adjuvant RT. Massachusetts General Hospital staff prefer to administer some preoperative RT to reduce iatrogenic tumor seeding associated with surgical violation of the tumor.…”

mentioning

confidence: 99%

High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors

Rotondo

Folkert

Liebsch

et al. 2015

SPI

139

119

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OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. RESULTS Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for R0/R1 margins and the absence of intralesional procedures. CONCLUSIONS High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.

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“…[14][15][16] Unlike conventional photon beams, ion beams emit a low dose of radiation along their path of travel and deliver a maximal dose at the target, beyond which the radiation dose decreases sharply. 17 Proton beams are as excellent in their 'dose distribution' as carbon ion beams, but the biological effectiveness of carbon ion beams is several times higher than that of a proton or photon beam. 17 Therefore, CIRT is more effective than proton beam radiotherapy.…”

Section: -13mentioning

confidence: 99%

Total spondylectomy following carbon ion radiotherapy to treat chordoma of the mobile spine

Matsumoto

Imagama

Ito

et al. 2013

The Bone & Joint Journal

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The main form of treatment of a chordoma of the mobile spine is total en bloc spondylectomy (TES), but the clinical results are not satisfactory. Stand-alone carbon ion radiotherapy (CIRT) for bone and soft-tissue sarcomas has recently been reported to have a high rate of local control with a low rate of local recurrence.We report two patients who underwent TES after CIRT for treating a chordoma in the lumbar spine with good medium-term outcomes. At operation, there remained histological evidence of viable tumour cells in both cases. After the combination use of TES following CIRT, neither patient showed signs of recurrence at the follow-up examination. These two cases suggest that CIRT should be combined with total spondylectomy in the treatment of chordoma of the mobile spine. Chordomas are thought to arise from cellular remnants of the notochord; they account for 1% to 4% of all malignant tumours of bone.

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Effect of Carbon Ion Radiotherapy for Sacral Chordoma: Results of Phase I-II and Phase II Clinical Trials

Cited by 82 publications

References 29 publications

Carbon ion radiotherapy for sacral chordoma

Carbon ion radiotherapy for sacral chordoma

High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors

Total spondylectomy following carbon ion radiotherapy to treat chordoma of the mobile spine

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