title: Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectiveness and toxicity of carbon ion radiotherapy in chordomas of the skull base.
  
  
  METHODS
  Between November 1998 and July 2005, a total of 96 patients with chordomas of the skull base have been treated with carbon ion radiation therapy (RT) using the raster scan technique at the Gesellschaft für Schwerionenforschung (GSI) in Darmstadt, Germany. All patients had gross residual tumors. Median total dose was 60 CGE (range, 60-70 CGE) delivered in 20 fractions within 3 weeks. Local control and overall survival rates were calculated using the Kaplan-Meier method. Toxicity was assessed according to the Common Terminology Criteria (CTCAE v.3.0) and the Radiation Therapy Oncology Group (RTOG) / European Organization for Research and Treatment of Cancer (EORTC) score.
  
  
  RESULTS
  Mean follow-up was 31 months (range, 3-91 months). Fifteen patients developed local recurrences after carbon ion RT. The actuarial local control rates were 80.6% and 70.0% at 3 and 5 years, respectively. Target doses in excess of 60 CGE and primary tumor status were associated with higher local control rates. Overall survival was 91.8% and 88.5% at 3 and 5 years, respectively. Late toxicity consisted of optic nerve neuropathy RTOG/EORTC Grade 3 in 4.1% of the patients and necrosis of a fat plomb in 1 patient. Minor temporal lobe injury (RTOG/EORTC Grade 1-2) occurred in 7 patients (7.2%).
  
  
  CONCLUSIONS
  Carbon ion RT offers an effective treatment option for skull-base chordomas with acceptable toxicity. Doses in excess of 75 CGE with 2 CGE per fraction are likely to increase local control probability.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.Daniela.Ertner@med.uni-heidelberg.de
authors.forename: Daniela
authors.initials: D
authors.lastname: Schulz-Ertner
authors.forename: Christian P
authors.initials: CP
authors.lastname: Karger
authors.forename: Alexandra
authors.initials: A
authors.lastname: Feuerhake
authors.forename: Anna
authors.initials: A
authors.lastname: Nikoghosyan
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
authors.forename: Oliver
authors.initials: O
authors.lastname: Jäkel
authors.forename: Lutz
authors.initials: L
authors.lastname: Edler
authors.forename: Michael
authors.initials: M
authors.lastname: Scholz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002250:Carbon Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002817:Chordoma / Q000401:mortality / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D019292:Skull Base Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D016019:Survival Analysis
chemical_list: D002250:Carbon Radioisotopes