title: Acute radiation-induced toxicity of heavy ion radiotherapy delivered with intensity modulated pencil beam scanning in patients with base of skull tumors.
abstract: OBJECTIVE
  The purpose of this paper is to evaluate acute radiation-induced toxicity of carbon ion therapy.
  
  
  METHODS
  From December 1997 to November 2000, 37 patients with chordomas and low-grade chondrosarcomas of the skull base have been treated with carbon ions at the heavy ion synchrotron (SIS) at GSI, Darmstadt. Tumor-conformal application of carbon beams was realized by intensity-controlled raster scanning in combination with pulse-to-pulse energy variation. The treatment planning procedure included a biological plan optimization. We applied a cobalt-Gray equivalent dose of 60GyE. Acute toxicity was assessed according to the common toxicity criteria (CTC).
  
  
  RESULTS
  Acute toxicity included skin reactions ( degrees I+ degrees II) in four patients, mucositis ( degrees I- degrees III) in eight patients, otitis and middle ear effusion in four, sinusitis in four, nausea/weight loss in one and edema of the temporal lobes in one patient. In two patients, preexisting neurological symptoms worsened. We did not observe acute morbidity > degrees III of normal tissues.
  
  
  CONCLUSIONS
  Scanning beam delivery of heavy charged particles is safe and reliable. No unexpected acute dose limiting toxicity was observed. With regard to toxicity, a substantial improvement compared to passive beam shaping technology is achieved.
authors.affiliation: Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Schulz-Ertner
authors.forename: Thomas
authors.initials: T
authors.lastname: Haberer
authors.forename: Michael
authors.initials: M
authors.lastname: Scholz
authors.forename: Christoph
authors.initials: C
authors.lastname: Thilmann
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.forename: Oliver
authors.initials: O
authors.lastname: Jäkel
authors.forename: Gerhard
authors.initials: G
authors.lastname: Kraft
authors.forename: Michael
authors.initials: M
authors.lastname: Wannenmacher
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002250:Carbon Radioisotopes; D002813:Chondrosarcoma / Q000175:diagnosis / Q000532:radiotherapy*; D002817:Chordoma / Q000175:diagnosis / Q000532:radiotherapy*; D003037:Cobalt Radioisotopes; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008417:Mastoiditis / Q000209:etiology; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D012852:Sinusitis / Q000209:etiology; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D013238:Stereotaxic Techniques
chemical_list: D002250:Carbon Radioisotopes; D003037:Cobalt Radioisotopes