Conformal rotation therapy with central axis beam block is a feasible alternative to intensity-modulated radiotherapy for chordomas of the cervical spine

Paraspinal tumours, such as chordoma, represent a treatment challenge for oncologists, requiring high dose to the target volume without exceeding the tolerance dose of the spinal cord. Intensity-modulated radiotherapy (IMRT) is helpful in achieving sharp dose gradients and conformation of dose to th...

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Published in:	Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 16; no. 7; pp. 449 - 456
Main Authors:	Jena, R., Luhana, F., Brooke, S.L., Geater, A.R., Jefferies, S.J., Burton, K.E., Laing, R.J.C., Burnet, N.G.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-10-2004
Subjects:	Aged Cervical Vertebrae - anatomy & histology Cervical Vertebrae - pathology Chordoma Chordoma - pathology Chordoma - radiotherapy Dose Fractionation Humans intensity-modulated radiotherapy Male Neoplasm Recurrence, Local - prevention & control Palliative Care Radiotherapy, Conformal - methods rotation therapy Spinal Cord Neoplasms - pathology Spinal Cord Neoplasms - radiotherapy Chordoma intensity-modulated radiotherapy rotation therapy
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Summary:	Paraspinal tumours, such as chordoma, represent a treatment challenge for oncologists, requiring high dose to the target volume without exceeding the tolerance dose of the spinal cord. Intensity-modulated radiotherapy (IMRT) is helpful in achieving sharp dose gradients and conformation of dose to the target volume. We present a simpler technique — conformal rotation therapy with a central axis beam block (CRT + BB), which can provide similar dose distributions. A patient with a cervical chordoma developed postoperative recurrence and was treated with high-dose palliative radiotherapy. Treatment was delivered using CRT + BB, with three fixed beams and three coplanar arcs. A dose of 62 Gy in 31 fractions was delivered to the 100% isodose, giving a maximum spinal cord dose of 49.6 Gy. The patient relapsed 2 years later, and was re-treated using the same technique to a dose of 57 Gy in 30 fractions. Estimates of spinal cord repair rates in primates were used to determine the tolerance dose of the spinal cord for re-treatment. The patient remained well for a further 25 months before developing local recurrence, which was treated with palliative chemotherapy. Re-treatment plans using CRT + BB and IMRT were compared. Dose–volume histograms show equivalence of dose to the spinal cord, although the IMRT plan delivered a slightly higher dose to tumour and lower dose to surrounding soft tissues. Treatment using CRT + BB requires careful planning and discussion with neurosurgeons before surgery. The normal curvature of the cervical spine must be eliminated if possible, and the patient must be immobilised with the neck horizontal. If these geometric constraints can be satisfied, then CRT + BB can be used as a safe and effective alternative treatment to IMRT for tumours at this site.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0936-6555 1433-2981
DOI:	10.1016/j.clon.2004.06.017