title: Proton beam radiotherapy: report of the first ten patients treated at the "Centro Nazionale di Adroterapia Oncologica (CNAO)" for skull base and spine tumours.
abstract: OBJECTIVE
  The Italian National Centre for Oncological Hadrontherapy (Centro Nazionale di Adroterapia Oncologica, CNAO), equipped with a proton and ion synchrotron, started clinical activity in September 2011. The clinical and technical characteristics of the first ten proton beam radiotherapy treatments are reported.
  
  
  METHODS
  Ten patients, six males and four females (age range 27-73 years, median 55.5), were treated with proton beam radiotherapy. After one to two surgical procedures, seven patients received a histological diagnosis of chordoma (of the skull base in three cases, the cervical spine in one case and the sacrum in three cases) and three of low-grade chondrosarcoma (skull base). Prescribed doses were 74 GyE for chordoma and 70 GyE for chondrosarcoma at 2 GyE/fraction delivered 5 days per week.
  
  
  RESULTS
  Treatment was well tolerated without toxicity-related interruptions. The maximal acute toxicity was grade 2, with oropharyngeal mucositis, nausea and vomiting for the skull base tumours, and grade 2 dermatitis for the sacral tumours. After 6-12 months of follow-up, no patient developed tumour progression.
  
  
  CONCLUSIONS
  The analysis of the first ten patients treated with proton therapy at CNAO showed that this treatment was feasible and safe. Currently, patient accrual into these as well as other approved protocols is continuing, and a longer follow-up period is needed to assess tumour control and late toxicity.
authors: Fondazione CNAO, Strada Privata Campeggi, 27100, Pavia, Italy, roberto.orecchia@cnao.it.
authors: Roberto
authors: R
authors: Orecchia
authors: Viviana
authors: V
authors: Vitolo
authors: Maria Rosaria
authors: MR
authors: Fiore
authors: Piero
authors: P
authors: Fossati
authors: Alberto
authors: A
authors: Iannalfi
authors: Barbara
authors: B
authors: Vischioni
authors: Anurita
authors: A
authors: Srivastava
authors: Jeffrey
authors: J
authors: Tuan
authors: Mario
authors: M
authors: Ciocca
authors: Silvia
authors: S
authors: Molinelli
authors: Alfredo
authors: A
authors: Mirandola
authors: Gloria
authors: G
authors: Vilches
authors: Andrea
authors: A
authors: Mairani
authors: Barbara
authors: B
authors: Tagaste
authors: Marco
authors: M
authors: Riboldi
authors: Giulia
authors: G
authors: Fontana
authors: Guido
authors: G
authors: Baroni
authors: Sandro
authors: S
authors: Rossi
authors: Marco
authors: M
authors: Krengli
mesh_terms: D000328:Adult; D000368:Aged; D002813:Chondrosarcoma / Q000532:radiotherapy*; D002817:Chordoma / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011522:Protons; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D011881:Radiotherapy, Computer-Assisted; D019292:Skull Base Neoplasms / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000532:radiotherapy*; D017356:Synchrotrons; D014057:Tomography, X-Ray Computed
chemical_list: D011522:Protons