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CARBON ION THERAPY FOR SACRAL CHORDOMAS Tadashi KAMADA, MD Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba,

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Presentation on theme: "CARBON ION THERAPY FOR SACRAL CHORDOMAS Tadashi KAMADA, MD Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba,"— Presentation transcript:

1 CARBON ION THERAPY FOR SACRAL CHORDOMAS Tadashi KAMADA, MD Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba, JAPAN CTOS 14 th Annual Meeting November 13-15, 2008 London UK

2 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

3 Carbon ion therapy for chodoma : Background & Material ◆ Surgery is the mainstay of treatment for chordomas. However, complete excision is frequently difficult in S2 or higher lesions without severe functional loss. ◆ On the other hand, chordoma shows minimal response to radiation or chemotherapy. ◆ Between 1996 and 2007, 95 patients with sacral chordoma were included in the phase I/II (Kamada, JCO 2002) and phase II (Kamada, JCO 2008) study of carbon ion therapy for bone and soft tissue sarcomas.

4 No. of Pts: 95 sacral chordma Gender: 68 males / 27 females Age: (median65) Presentation: 84 primary / 11 post op rec Tumor Diameter : 3 ~ 17 cm ( Median : 9 cm ) Tumor Volume : 47 ~ 1497 cc ( Median : 370 cc ) (From Jun 1996 to Feb 2007) Patients Characteristics

5 L510 S129 S229 S39 S4~7 Post op rec11 Sacral Chordoma : Level of Invasion More than 80 % were S2 or higher level lesions

6 Carbon ion therapy - all 16 Fractions over 4week Total dose: GyE : 2, 70.4GyE : 86, 73.6GyE : 7 ( GyE/fr.) Number of port : Two ports : 2, Three ports : 91, Patch : 2 代表的なものに変更 96% 90% 50% 30% 10% With 3 ports; 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 !

7 Probability 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)

8 Radiation Morbidity Acute grade No Skin GI tract Late grade No Skin * 2*0 GI tract However, 15 patients required persistent medication for peripheral neuropathy in this series. *receiving TD of 73.6GyE

9 DVH (n=44) Severe Moderate None-slight (ml) (GyE) 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

10 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)

11 Sacral Chordoma (S1) 57yo Female C- Ion RT 70.4GyE/16Fr/4wks Dose distributionBefore treatment 54 months after Alive no evidence of re-growth of tumor and ambulant. Working as a housewife with slight urinary incontinence CTV:991cc

12 Local Control and Survival Rate in Chordoma No. SitetreatmentLocal Survival of Pts.5-year5year10year (new pts /y) MGH 1) 21Ssurgery 77%-50% ( 1.1) Sweden 2) 39S+Spsurgery 4484% (1.1) MGH. 3) 27Ssurgery (2.7 )+ Proton LBL 4) 14Ssurgery (1.2 ) + He-ion Mayo 5) 52Ssurgery (2.5 ) NIRS 95S C-ion (9 ) 1) J Bone Joint Surg ) Cancer )IJROBP ) IJROBP ) J Bone Joint Surg S:sacrum Sp:mobile spine (disease free)

13 ◆ 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

14 Carbon ion therapy is suggested to be an effective and safe treatment for sacral chordomas and could be a promising alternative to surgery. In Conclusion

15 Carbon ion therapy--New horizon in cancer treatment

16 Before RCC : 55yo Male IJROBP years after C-ion Rx 80.0GyE / 16 F No pain No bleeding No wound No anesthesia


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