Carbon Ion Radiotherapy for Skull Base Chordoma

ABSTRACT

Objective: To present the results of the clinical study of carbon ion radiotherapy (CIRT) for skull base and paracervical spine tumors at the National Institute of Radiological Sciences in Chiba, Japan. Methods: The study is comprised of three protocols: a pilot study, a phase I/II dose escalation study, and a phase II study. All the patients were treated by 16 fractions for 4 weeks with total doses of 48.0, 52.8, 57.6, and 60.8 Gy equivalents (GyE). Results: As a result of the dose escalation study of CIRT for skull base tumors, a dose fractionation of 60.8 GyE/16 fractions for 4 weeks was decided as the recommended dose because of acceptable normal tissue reactions and good local tumor control. Conclusions: Preliminary results of the phase II clinical study of CIRT for skull base chordoma showed local control at 5 years at 100%, and normal tissues showed a mild reaction without any severe morbidity of important organs.

KEYWORDS

Chordoma - carbon ion radiotherapy - particle radiotherapy - skull base tumor

REFERENCES

• 1 Salisbury J R. The pathology of the human notochord.  J Pathol. 1993;  171 253-255
• 2 Debus J, Hug E B, Liebsch N J et al.. Brainstem tolerance to conformal radiotherapy of skull base tumors.  Int J Radiat Oncol Biol Phys. 1997;  39 967-975
• 3 Schulz-Ertner D, Karger C P, Feuerhake A et al.. Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas.  Int J Radiat Oncol Biol Phys. 2007;  68 449-457
• 4 Feuvret L, Noel G, Weber D C et al.. A treatment planning comparison of combined photon-proton beams versus proton beams-only for the treatment of skull base tumors.  Int J Radiat Oncol Biol Phys. 2007;  69 944-954
• 5 Vargas C, Fryer A, Mahajan C et al.. Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer.  Int J Radiat Oncol Biol Phys. 2008;  70 744-751
• 6 Munzenrider J E, Liebsch N J. Proton therapy for tumors of the skull base.  Strahlenther Onkol. 1999;  175(Suppl. 2) 57-63
• 7 Igaki H, Tokuue K, Okumura T et al.. Clinical results of proton beam therapy for skull base chordoma.  Int J Radiat Oncol Biol Phys. 2004;  60 1120-1126
• 8 Noël G, Feuvret L, Calugaru V et al.. Chordomas of the base of the skull and upper cervical spine. One hundred patients irradiated by a 3D conformal technique combining photon and proton beams.  Acta Oncol. 2005;  44 700-708
• 9 Weber D C, Rutz H P, Pedroni E S et al.. Results of spot-scanning proton radiation therapy for chordoma and chondrosarcoma of the skull base: the Paul Scherrer Institut experience.  Int J Radiat Oncol Biol Phys. 2005;  63 401-409
• 10 Mendenhall W M, Mendenhall C M, Lewis S B et al.. Skull base chordoma.  Head Neck. 2005;  27 159-165
• 11 Jereczek-Fossa B A, Krengli M, Orecchia R. Particle beam radiotherapy for head and neck tumors: radiobiological basis and clinical experience.  Head Neck. 2006;  28 750-760
• 12 Terahara A, Niemierko A, Goitein M et al.. Analysis of the relationship between tumor dose inhomogeneity and local control in patients with skull base chordoma.  Int J Radiat Oncol Biol Phys. 1999;  45 351-358
• 13 Kanai T, Endo M, Minohara S et al.. Biophysical characteristics of HIMAC clinical irradiation system for heavy-ion radiation therapy.  Int J Radiat Oncol Biol Phys. 1999;  44 201-210
• 14 WHO Handbook for Reporting the Results of Cancer Treatment. Definitions of Objective Response. Geneva; World Health Organization 1979 Offset Publication No. 48 23-25
• 15 Kaplan E L, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481