Image-Guided Intensity-Modulated Photon Radiotherapy Using Multifractionated Regimen to Paraspinal Chordomas and Rare Sarcomas

Journal Article · Sat Dec 01 04:00:00 EST 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.05.019· OSTI ID:21039674

Lovelock, D Michael ^[1]; Bilsky, Mark H ^[2]; Hunt, Margaret A; Zatcky, Joan N.P.; Yamada, Yoshiya ^[3]

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1. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
2. Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
3. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

Purpose: Image-guided intensity-modulated radiotherapy enables delivery of high-dose radiation to tumors close to the spinal cord. We report our experience with multifractionated regimens using image-guided intensity-modulated radiotherapy to treat gross paraspinal disease to doses beyond cord tolerance. Methods and Materials: We performed a retrospective review of 27 consecutive patients with partially resected or unresectable paraspinal tumors irradiated to >5,300 cGy in standard fractionation. Results: The median follow-up was 17.4 months (range, 2.1-47.3). Eighteen sarcomas, seven chordomas, and two ependymomas were treated. The median dose to the planning target volume was 6,600 cGy (range, 5,396-7,080) in 180- or 200-cGy fractions. The median planning target volume was 164 cm{sup 3} (range, 29-1,116). Seven patients developed recurrence at the treatment site (26%), and 6 of these patients had high-grade tumors. Three patients with recurrence had metastatic disease at the time of radiotherapy. The 2-year local control rate was 65%, and the 2-year overall survival rate was 79%. Of the 5 patients who died, 4 had metastatic disease at death. Twenty-three patients (84%) reported either no pain or improved pain at the last follow-up visit. Sixteen patients discontinued narcotic use after treatment (62.5%). Twenty-three patients (89%) had a stable or improved American Spine Injury Association score at the last follow-up visit. No patient experienced radiation-induced myelopathy. Conclusions: The dose to paraspinal tumors has traditionally been limited to respect cord tolerance. With image-guided intensity-modulated radiotherapy, greater doses of radiation delivered in multiple fractions can be prescribed with excellent target coverage, effective palliation, and acceptable toxicity and local control.

• OSTI ID: 21039674
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 69; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
DEATH
IMAGES
INJURIES
IRRADIATION
METASTASES
NARCOTICS
PAIN
PATIENTS
PLANNING
RADIATION DOSES
RADIOTHERAPY
REVIEWS
SARCOMAS
SPINAL CORD
TOLERANCE
TOXICITY
VERTEBRAE