Advertisement

Strahlentherapie und Onkologie

, Volume 175, Supplement 2, pp 57–63 | Cite as

Proton therapy for tumors of the skull base

  • John E. Munzenrider
  • Norbert J. Liebsch
Clinical Aspects of Hadron Therapy

Abstract

Charged particle beams are ideal for treating skull base and cervical spine tumors: dose can be focused in the target, while achieving significant sparing of the brain, brain stem, cervical cord, and optic nerves and chiasm. For skull base tumors, 10-year local control rates with combined proton-photon therapy are highest for chondrosarcomas, intermediate for male chordomas, and lowest for female chordomas (94%, 65%, and 42%, respectively). For cervical spine tumors, 10-year local control rates are not significantly different for chordomas and chondrosarcomas (54% and 48%, respectively), nor is there any difference in local control between males and females. Observed treatment-related morbidity has been judged acceptable, in view of the major morbidity and mortality which accompany uncontrolled tumor growth.

Key Words

Proton therapy Skull base Chordoma Chondrosarcoma 3D conformal radiation therapy 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Castro JR, Petti PL, Blakely EA, et al. Particle Radiation Therapy. In: Leibel SA, Phillips TL (eds.). Textbook of Radiotherapy. New York: WB Saunders, 1998, pp. 1223–40.Google Scholar
  2. 2.
    Munzenrider JE, Adams J, Liebsch NJ. Skull Base Tumors: Treatment with Three-Dimensional Planning and Fractionsated X-ray and Proton Radiotherapy. In: Leibel SA, Phillips TL (eds.). Textbook of Radiotherapy. New York: W B Saunders, 1988, pp. 347–56.Google Scholar
  3. 3.
    Brahme A. Dosimetric precision requirements in radiation therapy. Acta-Radiol [Oncol] 1984;23(Fasc 5):379–91.Google Scholar
  4. 4.
    Suit HD, Walker AM. Predictors of Radiation Response in Use Today: Criteria for New Assays and Methods of Verification. In: Chapman JD, Peters LJ, HR Withers HR (eds.). Prediction of Tumor Treatment Response. Pergamon Press, 1988, pp. 3–19.Google Scholar
  5. 5.
    Suit HD, duBois W. The Importance of Optimal Treatment Planning in Radiation Therapy. Int J Radiat Oncol Biol Phys (F. Ellis Dedicatory Issue) 1991;21:1471–8.Google Scholar
  6. 6.
    Suit HD. Potential for improving survival rates for the cancer patient by increasing the efficacy of treatment of the primary lesion. [American Society of Therapeutic Radiology Presidential Address October 1981] Cancer 1982;50:1227–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Suit HD. Local Control and Patient Survival. Int J Radiat Oncol Biol Phys 1992;23:653–60.PubMedGoogle Scholar
  8. 8.
    Suit HD, Verhey LJ. Precision in Megavoltage Radiotherapy. Brit J Radiology 1988;Suppl. 22:17–24.Google Scholar
  9. 9.
    Suit HD, Urie MU, Efird JT. Proton beams in clinical radiation therapy. Principles & Practice of Oncology 1992;6:1–15.Google Scholar
  10. 10.
    Urano M, Goitein M, Verhey LJ, et al. Relative biological effectiveness of modulated proton beams in various murine tissues. Int J Radiat Oncol Biol Phys 1984;10:509–14.PubMedGoogle Scholar
  11. 11.
    Yashkin PN, Silin DI, Zolotov VA, et al. Relative biological effectiveness of proton medical beam at Moscow Synchotron determined by the Chines Hamster Cells assay. Int J Radiat Oncol Biol Phys 1995;31:535–40.PubMedGoogle Scholar
  12. 12.
    Miller DW. A review of proton beam radiotherapy. Med Phys 1943-1954, 1995;22.Google Scholar
  13. 13.
    Austin-Seymour M, Kalet I, McDonald J, et al. Three dimensional planning target volumes: a model and software tool. Int J Radiation Oncol Biol Phys 1995;33:1073–80.Google Scholar
  14. 14.
    Koehler AM, Preston, WM. Protons in radiation therapy. Comparative dose distributions for protons, photons, and electrons. Radiology 1972; 104:191–5.PubMedGoogle Scholar
  15. 15.
    Goitein M, Abrams M. Multi-dimensional treatment planning: 1. Delineation of anatomy. Int J Radiat Oncol Biol Phys 1983;9:777–87.PubMedGoogle Scholar
  16. 16.
    Goitein M. Compensation for inhomogeneities in charged particle radiotherapy using computed tomography. Int J Radiat Oncol Biol Phys 1978; 4:499–508.PubMedGoogle Scholar
  17. 17.
    Urie M, Goitein M, Wagner M. Compensating for heterogeneities in proton radiation therapy. Phys Med Biol 1983;29:553–66.CrossRefGoogle Scholar
  18. 18.
    Verhey LJ, Goitein M, Munzenrider JE, et al. Precise positioning of patients for radiation therapy. Int J Radiat Oncol Biol 1982;8:289–94.CrossRefGoogle Scholar
  19. 19.
    Gall KP, Verhey LJ, Wagner M. Computer-assisted positioning of radiotherapy patients using implanted radiopaque fiducials. Med Phys 1993;20:1153–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Goitein M, Abrams M, Rowell D, et al. Multi-dimensional treatment planning: II. Beam’s eye-view, back projection and projection through CT sections. Int J Radiat Oncol. Biol. Phys 1983;9:789–97.PubMedGoogle Scholar
  21. 21.
    Tatsuzaki H, Urie MM. Importance of precise positioning for proton beam therapy in the base of skull anand cervical spine. Int J Radiat Oncol Biol Phys 1991;21:757–65.PubMedGoogle Scholar
  22. 22.
    Dahlin DC. Bone Tumors, 2nd edition Springfield, IL, Charles C Thomas, 1967, Netherlands Committee on Bone Tumors (ed): Radiologic Atlas of Bone Tumors. Baltimore: Williams and Wilkins, 1966, Vol 1.Google Scholar
  23. 23.
    Volpe NJ, Liebsch NJ, Munzenrider JE, et al. Neuro-ophthalmic findings in chordoma and chondrosarcoma of the skull base. Am J Ophthalmol 1993;115:97–104.PubMedGoogle Scholar
  24. 24.
    Halperin EC. Why is female sex an independent predictor of shortened overall survival after proton/photon radiation therapy for skull base chordomas? Int J Rad Oncol Biol Phys 1997;38:225.Google Scholar
  25. 25.
    O’Connell JX, Renard LG, Liebsch NJ, et al. Base of skull chordoma: A correlelative study of histologic and clinical features of 62 cases. Cancer 1994;74:2261–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Rosenberg AE, Brown GA, Bhan AK, et al. Chondroid chordoma: a varient of chordoma: a morphological and immunohistochemical study. Am J Clin Pathol 1994;101:36–41.PubMedGoogle Scholar
  27. 27.
    Al-Mefti O, Borba AB. Skull base chordomas: a management challenge. J Neurosurgery 1997;86:182–9.CrossRefGoogle Scholar
  28. 28.
    Raffel C, Wright DC, Gutin PH, et al. Cranial Chordomas: Clinical Presentation and Results of Operative and Radiation Therapy in Twenty-six Patients. Neurosurgery 1985;17:703–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Austin-Seymour M, Munzenrider J, Goitein M, et al. Fractionated proton radiation therapy of chordoma and low grade chondrosarcoma of the base of skull. Journal of Neurosurgery 1989;70:13–17.43.PubMedGoogle Scholar
  30. 30.
    Castro JR, Lindstadt DE, Bahary JP, et al. Experience in charged particle irradiation of tumors of the skullbase: 1977–1992. Int J Rad Oncol Biol. Phys 1994;29:647–56.Google Scholar
  31. 31.
    Benk V, Liebsch NJ, Munzenrider JE, et al. Base of Skull and Cervical Spine Chordomas in Children Treated by High Dose Irradiation. Int J Rad Oncol Biol Phys 1995;31:577.Google Scholar
  32. 32.
    Oot RF, Melville GE, New PF, et al. The role of MR and CT in evaluating clival chordomas and chondrosarcomas. Am J Roentgen 1988;567–75.Google Scholar
  33. 33.
    Austin JP, Urie MM, Cardenosa G, et al. Probable causes of recurrence in patients with chordoma and chondrosarcoma of the base of skull and cervical spine. Int J Radiation Oncology Biol Phys 1993;25:439–44.Google Scholar
  34. 34.
    Fagundes MA, Hug EB, Liebsch NJ, et al. Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse. Int J Rad Oncol Biol Phys 1995;33:579.Google Scholar
  35. 35.
    Debus J, Hug EB, Munzenrider JE, et al. Bramstem tolerance to conformal radiotherapy of skull base tumors. Int J Radiation Oncology Biol Phys 1997;39:976.Google Scholar
  36. 36.
    Liu MCC, Munzenrider JE, Finkelstein D, et al. Radiation myelopathy: incidence and dose-volume relationships in high dose irradiation of the cervical spinal cord. Int J Radiation Oncology Biol Phys 1997;39(S1):272.Google Scholar
  37. 37.
    Santoni R, Liebsch NJ, Finkelstein D, et al. Int J Radiation Oncology Biol Phys 1998;41:59–68.Google Scholar
  38. 38.
    Glosser G, McManus P, Munzenrider JE, et al. Neuropsychological function in adults after high dose fractionated radiation therapy of skull base tumors. Int J Rad Oncol Biol Phys 1997;38:231.Google Scholar
  39. 39.
    Urie M, Goitein M. Variable versus fixed modulation of proton beams for treatment in the cranium. Med Phys 1989;16:593.PubMedCrossRefGoogle Scholar
  40. 40.
    Habrand JL, Austin-Seymour M, Birnbaum S, et al. Neurovisual outcome following proton radiation therapy. Int J Rad Oncol Biol Phys 1989;16:1601–6.Google Scholar
  41. 41.
    Kim J, Hug EB, Liebsch NJ, et al. Tolerance of optic nerve to high dose fractionated proton and X-ray therapy. Int J Radiation Oncology Biol Phys 1997;39:272.Google Scholar
  42. 42.
    Schoenthaler R, Fullerton B, Maas A, et al. Relationship between dose to auditory pathways and audiological outcomes in skull base tumor patients receiving high dose proton/photon radiotherapy. Int J Rad Oncol Biol Phys 1996;36:291.CrossRefGoogle Scholar
  43. 43.
    Urie MU, Fullerton B, Tatsuzaki H, et al. A dose response analysis of injury to cranial nerves and/or nuclei following proton beam radiation therapy. Int J Radiat Oncol Biol Phys 1992;23:27–39.PubMedGoogle Scholar
  44. 44.
    Slater JD, Austin-Seymour M, Munzenrider J, et al. Endocrine function following high dose proton therapy for tumors of the upper clivus. Int J Rad Oncol Biol Phys 1988;15:607–11.Google Scholar
  45. 45.
    Slater JM, Archambeau JO, Miller DW, et al. The proton treatment center at Loma Linda University Medical Center: Rationale for and description of its development. Int J Radiat Oncol Biol Phys 1992;22:383–9.PubMedGoogle Scholar
  46. 46.
    Catton C, O’Sullivan B, Bell R, et al. Chordoma: Long-term follow-up after radical photon irradiation. Radiother Oncol 1996;41:67.PubMedGoogle Scholar

Copyright information

© Urban & Vogel 1999

Authors and Affiliations

  • John E. Munzenrider
    • 1
  • Norbert J. Liebsch
    • 1
  1. 1.Department of Radiation Oncology, Massachusett General HospitalHarvard University Medical SchoolBostonUSA

Personalised recommendations

Cite article

Buy options