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Pencil beam scanning proton radiotherapy in the treatment of adult chordoma and chondrosarcoma
Author(s): ,
S. Vinakurau
Affiliations:
Proton Therapy Center Czech, Pague, Czech Republic
,
J. Kubes
Affiliations:
Proton Therapy Center Czech, Pague, Czech Republic
,
B. Ondrova
Affiliations:
Proton Therapy Center Czech, Pague, Czech Republic
,
P. Vitek
Affiliations:
Proton Therapy Center Czech, Pague, Czech Republic
,
V. Vondracek
Affiliations:
Proton Therapy Center Czech, Pague, Czech Republic
,
J. Luxemburgova
Affiliations:
Proton Therapy Center Czech, Pague, Czech Republic
M. Kaspar
Affiliations:
Proton Therapy Center Czech, Pague, Czech Republic
EANS Academy. Vinakurau S. Oct 21, 2018; 226067; EP12032
Stepan Vinakurau
Stepan Vinakurau
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Introduction: Proton radiotherapy with PBS (pencil beam scanning) allows achieving dose escalation and better dose distribution for critical organs with better coverage of a target volume, in comparison with modern photon beam techniques incl. IMRT. PBS reduces the risk of side effects like a risk of vision deterioration, ototoxicity, neurotoxicity etc.. Experiences with PBS in the treatment of adult chordoma and chondrosarcoma, will be presented below.
Matherial and methods: From Mar 2013 to Jan 2018 we have treated: 17 patients with chondrosarcoma (CHS) and 28 patients with chordoma (CH). Patients were treated with IMPT (proton radiotherapy with modulated intensity) with doses 70,4 Gy (50-74GyE) for chondrosarcoma and 72,1 Gy (57,6-78GyE) for chordoma. A lower dose (below 68GyE) wasused for cases of second radiotherapy.
Results: 16 (94%) patients with CHS and 24 (85%) patients with CH are alive. 16 (94%) patients with CHS and 22 (79%) patients with CH are alive and without the disease. Acute toxicity is generally mild despite the large target volumes and application of high dose, with skin toxicity and dysphagia as the most frequent acute side effects. Administration of antiedematic therapy was necessary in 5 patients. Serious late toxicity (grade 2 and higher, RTOG) was observed in 1 (6%) patient with CHS and 5 (17,5%) patients with CH so far. Brain radionecrosis occurred in 1 (94%) patient with CHS and 6 (21%) patients with CH.
Conclusion: Proton radiotherapy is feasible for chordoma and chondrosarcoma with excellent dosimetry results and mild acute toxicity. A most serious brain toxicity in brain is ranionecrosis, but it is mostly oligosymptomatic. Oncological outcome seems to be promising and late toxicity acceptable.
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