ion radiotherapy for sacral chordomas骶骨脊索瘤的碳离子放射治疗课件

CARBON ION THERAPY FOR SACRAL CHORDOMAS Tadashi KAMADA, MD Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba, JAPAN CTOS 14th Annual Meeting November 13-15, 2008 London UK Carbon beam has a definite range and the Bragg peak.In addition to this physical selectivity, ionization is enormous at the Bragg peak, and showing biological advantages such as cell cycle independent effect. Therefore, carbon beam could be a potentially curable armament for radio-resistant tumors such as chordoma. Bragg peak Carbon ion therapy for chodoma : Background right-left, left-right anterior-posterior(patch) With 3 ports; right-left, left-right, posterior-anterior Carbon ion Dose Distribution in Sacral Chordoma Bowels were spared ! 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Probability 01224364860728496108120 Months 5 year OS: 86% 5 year LC: 88 % Overall Survival and Local Control after Carbon Ion Therapy in Sacral Chordoma Sacral Chordoma 95 patients Median survival time42 mo (13-112) Median time to local failure35 mo(13-60) Radiation Morbidity Acute grade No.01234 5 Skin 9508111300 GI tract 95932000 0 Late grade No.01234 5 Skin 95 08652* 2*0 GI tract 959410000 However, 15 patients required persistent medication for peripheral neuropathy in this series. *receiving TD of 73.6GyE DVH (n=44) Severe Moderate None-slight (ml) (GyE) 0 5 10 15 20 25 01020304050607080 DVHs of 44 Sciatic Nerve According to the Sciatic Symptoms in 22 patients with Sacral Chordoma Volume This slide shows DVHs of 44 sciatic nerves in 22 patients with sacral chordoma receiving total dose of 70.4 to 73.6 GyE followed more than 2 years. We found that length of more than 10cm, and a total dose of 70GyE could be a critical point for sciatic nerve outcome. Now, we give 67.4GyE for sacral chordoma. 70GyE and 10cm Before treatment 60 m after 70.4 GyE 66 months after, no neurological deficit, and spending normal life Carbon Ion Radiotherapy for Sacral Chordoma (S2, 65 yo, Male) Sacral Chordoma (S1) 57yo Female C- Ion RT 70.4GyE/16Fr/4wks Dose distributionBefore treatment54 months after Alive no evidence of re-growth of tumor and ambulant. Working as a housewife with slight urinary incontinence CTV:991cc Local Control and Survival Rate in Chordoma No. SitetreatmentLocal Survival of Pts.5-year5year10year (new pts /y) MGH 1) 21Ssurgery 77%-50% 1972-1992 (1.1) Sweden 2) 39S+Spsurgery 4484%64 1963-1998 (1.1) MGH. 3) 27Ssurgery728262 1982-2002 (2.7 )+ Proton LBL 4) 14Ssurgery 558522 1977-1989 (1.2 )+ He-ion Mayo 5) 52Ssurgery567452 1980-2001 (2.5 ) NIRS 95S C-ion 8886- 1996-2007.2(9 ) 1) J Bone Joint Surg. 1998 2) Cancer.2000 3)IJROBP.2006 4) IJROBP.1993 5) J Bone Joint Surg. 2005 S:sacrum Sp:mobile spine (disease free) Five years overall survival rate (86%) and Local control rate (88%) in patients with sacral chordoma treated by carbon ion therapy are similar to or even better than those in reported data on patients treated by surgical resection. Four patients treated with a total dose of 73.6 GyE experienced Grade 3/4 skin complications. No other treatment-related surgical interventions including colostomy or urinary diversion were carried out. Summary Carbon ion therapy is suggested to be an effective and safe treatment for sacral chordomas and could be a promising alternative to surgery. In C