Image-guided intensity-modulated photon radiotherapy using multifractionated regimen to paraspinal chordomas and rare sarcomas Journal Article


Authors: Terezakis, S. A.; Lovelock, D. M.; Bilsky, M. H.; Hunt, M. A.; Zatcky, J.; Yamada, Y.
Article Title: Image-guided intensity-modulated photon radiotherapy using multifractionated regimen to paraspinal chordomas and rare sarcomas
Abstract: 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 cm3 (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. © 2007 Elsevier Inc. All rights reserved.
Keywords: adult; clinical article; treatment outcome; aged; middle aged; survival rate; retrospective studies; cancer recurrence; intensity modulated radiation therapy; drug withdrawal; treatment planning; cancer patient; follow up; cancer grading; cancer palliative therapy; treatment indication; metastasis; radiotherapy; cancer pain; retrospective study; sarcoma; tumors; radiotherapy, intensity-modulated; radiation dose fractionation; spinal cord; spinal neoplasms; scoring system; ependymoma; inoperable cancer; photons; fractionation; dose fractionation; radiation dose distribution; chordoma; diseases; spinal cord disease; narcotic agent; rare disease; stereotactic radiotherapy; image-guided radiotherapy; paraspinal tumors; drug dosage; american spine injury association score
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 69
Issue: 5
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2007-12-01
Start Page: 1502
End Page: 1508
Language: English
DOI: 10.1016/j.ijrobp.2007.05.019
PUBMED: 17689028
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 4" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Yoshiya Yamada
    376 Yamada
  2. Mark H Bilsky
    230 Bilsky
  3. Joan M Zatcky
    36 Zatcky
  4. Dale M Lovelock
    150 Lovelock
  5. Margie A Hunt
    259 Hunt