title: Charged particle radiotherapy for lesions encircling the brain stem or spinal cord.
abstract: Since 1981, a specialized technique has been under development at the University of California Lawrence Berkeley Laboratory for charged particle irradiation of tumors partially or completely encircling the brain stem or spinal cord. By dividing the target volume into two or more portions and using a combination of beams, a reasonably homogeneous irradiation of the target volume can be obtained which protects critical CNS structures from over-irradiation. This technique requires knowledge of the physical and biological effects of charged particles, precise, reproducible patient immobilization, careful treatment planning based upon Metrizamide contrast CT and/or MRI scanning, compensation for tissue inhomogeneities, and accurate, verifiable radiation delivery. Uncertainties in the dose distribution must be taken into account when prescribing treatment. We have used this technique in 47 patients with a variety of tumors abutting the brain stem and spinal cord, including chordoma, chondrosarcoma, meningioma, osteosarcoma and metastatic tumors. The results have shown a significant local control rate (62%) and the incidence of serious complications has been acceptable (13%). The median follow-up is 20 months with a range of 6-90 months. We conclude that charged particles can be safely and effectively used to irradiate lesions encircling the brain stem or spinal cord to doses higher than can be achieved with low-LET irradiation.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco School of Medicine.
authors.forename: J R
authors.initials: JR
authors.lastname: Castro
authors.forename: J M
authors.initials: JM
authors.lastname: Collier
authors.forename: P L
authors.initials: PL
authors.lastname: Petti
authors.forename: V
authors.initials: V
authors.lastname: Nowakowski
authors.forename: G T
authors.initials: GT
authors.lastname: Chen
authors.forename: J T
authors.initials: JT
authors.lastname: Lyman
authors.forename: D
authors.initials: D
authors.lastname: Linstadt
authors.forename: G
authors.initials: G
authors.lastname: Gauger
authors.forename: P
authors.initials: P
authors.lastname: Gutin
authors.forename: M
authors.initials: M
authors.lastname: Decker
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy*; D001933:Brain Stem; D002813:Chondrosarcoma / Q000532:radiotherapy; D002817:Chordoma / Q000532:radiotherapy; D006801:Humans; D007477:Ions; D010315:Particle Accelerators; D011379:Prognosis; D011882:Radiotherapy, High-Energy / Q000009:adverse effects / Q000379:methods; D013120:Spinal Cord Neoplasms / Q000532:radiotherapy*
chemical_list: D007477:Ions