scholarly journals Preliminary Result of Hyperfractionated High-Dose Proton Beam Radiotherapy for Pediatric Skull Base Chordomas

2017 ◽  
Vol 08 (04) ◽  
pp. 327-332
Author(s):  
Masashi Mizumoto ◽  
Hiroyoshi Akutsu ◽  
Tetsuya Yamamoto ◽  
Takashi Fukushima ◽  
Yoshiko Oshiro ◽  
...  
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
High Dose ◽  
Proton Beam Radiotherapy ◽  
Skull Base Chordomas

Pediatric Clival Chordoma: A Curable Disease that Conforms to Collins' Law

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 652-660 ◽  
Author(s):  
Marcio S Rassi ◽  
M Maher Hulou ◽  
Kaith Almefty ◽  
Wenya Linda Bi ◽  
Svetlana Pravdenkova ◽  
...  
Keyword(s):  
Overall Survival ◽  
Skull Base ◽  
Proton Beam ◽  
Statistical Significance ◽  
Progression Free Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Free Survival ◽  
Proton Beam Radiotherapy ◽  
Skull Base Chordomas

Abstract BACKGROUND Skull base chordomas in children are extremely rare. Their course, management, and outcome have not been defined. OBJECTIVE To describe the preeminent clinical and radiological features in a series of pediatric patients with skull base chordomas and analyze the outcome of a cohort who underwent uniform treatment. We emphasize predictors of overall survival and progression-free survival, which aligns with Collins’ law for embryonal tumors. METHODS Thirty-one patients with a mean age of 10.7 yr (range 0.8-22) harboring skull base chordomas were evaluated. We retrospectively analyzed the outcomes and prognostic factors for 18 patients treated by the senior author, with uniform management of surgery with the aim of gross total resection and adjuvant proton-beam radiotherapy. Mean follow-up was 119.2 mo (range 8-263). RESULTS Abducens nerve palsy was the most common presenting symptom. Imaging disclosed large tumors that often involve multiple anatomical compartments. Patients undergoing gross total resection had significantly increased progression-free survival (P = .02) and overall survival (P = .05) compared with those having subtotal resection. Those who lived through the period of risk for recurrence without disease progression had a higher probability of living entirely free of progression (P = .03; odds ratio = 16.0). Age, sex, and histopathological variant did not yield statistical significance in survival. CONCLUSION Long-term overall and progression-free survival in children harboring skull base chordomas can be achieved with gross surgical resection and proton-beam radiotherapy, despite an advanced stage at presentation. Collins’ law does apply to pediatric skull base chordomas, and children with this disease have a high hope for cure.

scholarly journals Review of skull base chordomas: prognostic factors and long-term results of proton-beam radiotherapy

2001 ◽  
Vol 10 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Eugen B. Hug
Keyword(s):  
Prognostic Factors ◽  
Skull Base ◽  
Proton Beam ◽  
The United States ◽  
Long Term Results ◽  
Severe Toxicity ◽  
Long Term Outcome ◽  
Proton Beam Radiotherapy ◽  
Skull Base Chordomas

Fractionated proton beam radiotherapy has been used for skull base tumors in the United States since the mid-70s, and more than 300 patients in whom diagnosis of chordoma of the skull base has been made have been treated. The ability to achieve high degrees of radiation dose conformity by using protons has resulted in higher radiation doses than can be delivered with conventional radiotherapy in the base of skull. High target volume doses have led to improved tumor control and patient survival. Side effects such as severe toxicity are acceptable considering the alternatives of uncontrolled tumor growth. The authors of various analyses have identified prognostic factors that can be used to predict a patient's chance of treatment success. On the horizon are important technical developments that will further increase dose conformity and increase target doses. In this paper the author reviews long-term outcome data and prognostic predictors for survival of patients with skull base chordomas based on the largest worldwide patient series.

scholarly journals Hyperfractionated high-dose proton beam radiotherapy for clival chordomas after surgical removal

2016 ◽  
Vol 89 (1063) ◽  
pp. 20151051 ◽  
Author(s):  
Yasutaka Hayashi ◽  
Masashi Mizumoto ◽  
Hiroyoshi Akutsu ◽  
Shingo Takano ◽  
Akira Matsumura ◽  
...  
Keyword(s):  
Proton Beam ◽  
Surgical Removal ◽  
High Dose ◽  
Proton Beam Radiotherapy

High-Dose proton beam radiotherapy of hepatocellular carcinoma: Preliminary results of a phase II trial

2004 ◽  
Vol 127 (5) ◽  
pp. S189-S193 ◽  
Author(s):  
David A. Bush ◽  
Donald J. Hillebrand ◽  
James M. Slater ◽  
Jerry D. Slater
Keyword(s):  
Hepatocellular Carcinoma ◽  
Proton Beam ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
High Dose ◽  
Proton Beam Radiotherapy ◽  
Preliminary Results

Proton beam therapy for skull base chordomas in 106 patients: A dose adaptive radiation protocol

2018 ◽  
Vol 128 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Vivien Fung ◽  
Valentin Calugaru ◽  
Stéphanie Bolle ◽  
Hamid Mammar ◽  
Claire Alapetite ◽  
...  
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
Adaptive Radiation ◽  
Proton Beam Therapy ◽  
Skull Base Chordomas

scholarly journals Proton therapy with a fixed beamline for skull-base chordomas and chondrosarcomas: outcomes and toxicity

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Konstantin Gordon ◽  
Igor Gulidov ◽  
Sergey Koryakin ◽  
Daniil Smyk ◽  
Tatyana Makeenkova ◽  
...  
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
Proton Therapy ◽  
Radiation Treatment ◽  
Tumour Progression ◽  
Treatment Interruptions ◽  
Rare Tumours ◽  
Skull Base Chordomas ◽  
Grade 3 ◽  
Base Of The Skull

Abstract Aim This study presents an analysis (efficacy and toxicity) of outcomes in patients with skull-base chordomas or chondrosarcomas treated with a fixed horizontal pencil proton beam. Background Chordomas (CAs) and chondrosarcomas (CSAs) are rare tumours that are usually located near the base of the skull and very close to the brain's most critical structures. Proton therapy (PT) is often considered the best radiation treatment for these diseases, but it is still a limited resource. Active scanning PT delivered via a fixed pencil beamline might be a promising option. Methods This is a single-centre experience describing the results of proton therapy for 31 patients with CA (n = 23) or CSA (n = 8) located near the base of the skull. Proton therapy was utilized by a fixed pencil beamline with a chair to position the patient between May 2016 and November 2020. Ten patients underwent resection (32.2%), 15 patients (48.4%) underwent R2 resection, and 6 patients had unresectable tumours (19.4%). In 4 cases, the tumours had been previously irradiated. The median PT dose was 70 GyRBE (relative biological efficacy, 1.1) [range, 60 to 74] with 2.0 GyRBE per fraction. The mean GTV volume was 25.6 cm3 [range, 4.2–115.6]. Patient demographics, pathology, treatment parameters, and toxicity were collected and analysed. Radiation-induced reactions were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. Results The median follow-up time was 21 months [range, 4 to 52]. The median overall survival (OS) was 40 months. The 1- and 2-year OS was 100%, and the 3-year OS was 66.3%. Four patients died due to non-cancer-related reasons, 1 patient died due to tumour progression, and 1 patient died due to treatment-related injuries. The 1-year local control (LC) rate was 100%, the 2-year LC rate was 93.7%, and the 3-year LC rate was 85.3%. Two patients with CSA exhibited progression in the neck lymph nodes and lungs. All patients tolerated PT well without any treatment interruptions. We observed 2 cases of ≥ grade 3 toxicity, with 1 case of grade 3 myelitis and 1 case of grade 5 brainstem injury. Conclusion Treatment with a fixed proton beam shows promising disease control and an acceptable toxicity rate, even the difficult-to-treat subpopulation of patients with skull-base chordomas or chondrosarcomas requiring dose escalation.

scholarly journals The safety and efficacy of high-dose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial

Cancer ◽  
2011 ◽  
Vol 117 (13) ◽  
pp. 3053-3059 ◽  
Author(s):  
David A. Bush ◽  
Zeid Kayali ◽  
Roger Grove ◽  
Jerry D. Slater
Keyword(s):  
Hepatocellular Carcinoma ◽  
Proton Beam ◽  
Prospective Trial ◽  
High Dose ◽  
Phase 2 ◽  
Safety And Efficacy ◽  
Proton Beam Radiotherapy

Skull base chordomas: a management challenge

1997 ◽  
Vol 86 (2) ◽  
pp. 182-189 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Luis A. B. Borba
Keyword(s):  
Radiation Therapy ◽  
Skull Base ◽  
Photon Beam ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Surgical Removal ◽  
High Dose ◽  
Previous Surgery ◽  
The Mean ◽  
Skull Base Chordomas

✓ Because of their critical location, invasive nature, and aggressive recurrence, skull base chordomas are challenging and, at times, frustrating tumors to treat. Both radical surgical removal and high-dose radiation therapy, particularly proton beam therapy, reportedly are effective in tumor control and improve survival rates. The authors posit that these tumors are best treated with radical surgery and proton—photon beam therapy. During the last 5 years, they treated 25 patients (15 females and 10 males) who harbored pathologically diagnosed skull base chordomas. The mean age of the patients was 38.4 years (range 8–61 years). Previous surgery or radiation therapy was performed at other institutions in seven and two patients, respectively. The authors performed 33 surgical procedures on 23 patients. Radical removal (defined as absence of residual tumor on operative inspection and postoperative imaging) was achieved in 10 patients; subtotal resection (defined as resection of > 90% of the tumor) was achieved in 11 patients; and partial resection (defined as resection of < 90% of the tumor) was achieved in two patients. Radical surgical removal included not only the excision of soft-tumor tissue, but also extensive drilling of the adjacent bone. Adjuvant therapy consisted of postoperative combined proton—photon beam therapy (given to 17 patients and planned for one patient) and conventional radiation therapy (two patients); three patients received no adjunct therapy. To date, four patients have died. One patient who had undergone previous surgery and sacrifice of the internal carotid artery died postoperatively from a massive stroke; one patient died from adenocarcinoma of the pancreas without evidence of recurrence; and two patients died at 25 and 39 months of recurrent tumor. Permanent neurological complications included third cranial nerve palsy (one patient) and hemianopsia (one patient); radiation necrosis occurred in three patients. Of the 21 patients followed for more than 3 months after surgery, 16 have had no evidence of recurrence and five (including the two mortalities noted above) have had recurrent tumors (four diagnosed clinically and one radiologically). The mean disease-free interval was 14.4 months. A longer follow-up period will, hopefully, support the early indication that radical surgical removal and postoperative proton—photon beam therapy is an efficacious treatment. The use of skull base approaches based on the tumor classification introduced in this paper is associated with low mortality and morbidity rates.

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