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

Stephanie A Terezakis, D. Michael Lovelock, Mark H. Bilsky, Margaret A. Hunt, Joan Zatcky, Yoshiya Yamada

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1502-1508
Number of pages7
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume69
Issue number5
DOIs
StatePublished - Dec 1 2007
Externally publishedYes

Fingerprint

Image-Guided Radiotherapy
Chordoma
Intensity-Modulated Radiotherapy
Photons
Sarcoma
radiation therapy
cancer
photons
tumors
dosage
pain
Radiation
planning
Neoplasms
radiation
narcotics
Recurrence
Pain
Ependymoma
spinal cord

Keywords

  • Chordoma
  • Image-guided radiotherapy
  • Paraspinal tumors
  • Sarcoma
  • Stereotactic radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Image-Guided Intensity-Modulated Photon Radiotherapy Using Multifractionated Regimen to Paraspinal Chordomas and Rare Sarcomas. / Terezakis, Stephanie A; Lovelock, D. Michael; Bilsky, Mark H.; Hunt, Margaret A.; Zatcky, Joan; Yamada, Yoshiya.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 69, No. 5, 01.12.2007, p. 1502-1508.

Research output: Contribution to journalArticle

Terezakis, Stephanie A ; Lovelock, D. Michael ; Bilsky, Mark H. ; Hunt, Margaret A. ; Zatcky, Joan ; Yamada, Yoshiya. / Image-Guided Intensity-Modulated Photon Radiotherapy Using Multifractionated Regimen to Paraspinal Chordomas and Rare Sarcomas. In: International Journal of Radiation Oncology, Biology, Physics. 2007 ; Vol. 69, No. 5. pp. 1502-1508.
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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.",
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AU - Zatcky, Joan

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