title: Image-guided intensity-modulated photon radiotherapy using multifractionated regimen to paraspinal chordomas and rare sarcomas.
abstract: OBJECTIVE
  Image-guided intensity-modulated radiotherapy enables delivery of high-dose radiation to tumors close to the spinal cord. We report our experience with multifractionated regimens using image-guided intensity-modulated radiotherapy to treat gross paraspinal disease to doses beyond cord tolerance.
  
  
  METHODS
  We performed a retrospective review of 27 consecutive patients with partially resected or unresectable paraspinal tumors irradiated to >5,300 cGy in standard fractionation.
  
  
  RESULTS
  The median follow-up was 17.4 months (range, 2.1-47.3). Eighteen sarcomas, seven chordomas, and two ependymomas were treated. The median dose to the planning target volume was 6,600 cGy (range, 5,396-7,080) in 180- or 200-cGy fractions. The median planning target volume was 164 cm3 (range, 29-1,116). Seven patients developed recurrence at the treatment site (26%), and 6 of these patients had high-grade tumors. Three patients with recurrence had metastatic disease at the time of radiotherapy. The 2-year local control rate was 65%, and the 2-year overall survival rate was 79%. Of the 5 patients who died, 4 had metastatic disease at death. Twenty-three patients (84%) reported either no pain or improved pain at the last follow-up visit. Sixteen patients discontinued narcotic use after treatment (62.5%). Twenty-three patients (89%) had a stable or improved American Spine Injury Association score at the last follow-up visit. No patient experienced radiation-induced myelopathy.
  
  
  CONCLUSIONS
  The dose to paraspinal tumors has traditionally been limited to respect cord tolerance. With image-guided intensity-modulated radiotherapy, greater doses of radiation delivered in multiple fractions can be prescribed with excellent target coverage, effective palliation, and acceptable toxicity and local control.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. terezaks@mskcc.org
authors: Stephanie A
authors: SA
authors: Terezakis
authors: D Michael
authors: DM
authors: Lovelock
authors: Mark H
authors: MH
authors: Bilsky
authors: Margaret A
authors: MA
authors: Hunt
authors: Joan
authors: J
authors: Zatcky
authors: Yoshiya
authors: Y
authors: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D002817:Chordoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D019583:Dose Fractionation, Radiation; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017785:Photons / Q000627:therapeutic use*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D013116:Spinal Cord; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy*