title: Surgical spacer placement prior carbon ion radiotherapy (CIRT): an effective feasible strategy to improve the treatment for sacral chordoma.
abstract: BACKGROUND
  Sacral chordoma (SC) is a neoplasm arising from residual notochordal cells degeneration. SC is difficult to manage mainly because of anatomic location and tendency to extensive spread. Carbon ion radiotherapy (CIRT) is highly precise to selectively deliver high biological effective dose to the tumor target sparing the anatomical structure on its path even if when SC is contiguous to the intestine, and a surgical spacer might be an advantageous tool to create a distance around the target volume allowing radical curative dose delivery with a safe dose gradient to the surrounding organs. This paper describes a double approach-open and hand-assisted laparoscopic-for a silicon spacer placement in patients affected by sacral chordoma undergoing carbon ion radiotherapy.
  
  
  METHODS
  Six consecutive patients have been enrolled for surgical spacer placement-open (three) or hand-assisted (three)-prior carbon ion radiotherapy treatment in order to increase efficacy of carbon ion radiotherapy minimizing its side effects.
  
  
  RESULTS
  Results showed that silicon spacer placement for SC treatment is feasible both via laparoscopic and laparotomic approach.
  
  
  CONCLUSIONS
  Its use might improve CIRT safety and thus efficacy for SC treatment.
authors: Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy. l.cobianchi@smatteo.pv.it.|IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy. l.cobianchi@smatteo.pv.it.|Department of General Surgery, IRCCS San Matteo Foundation, University of Pavia, Piazzale Golgi, Pavia, 27100, Italy. l.cobianchi@smatteo.pv.it.
authors: Cobianchi
authors: C
authors: Lorenzo
authors: Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.|IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy.
authors: Peloso
authors: P
authors: Andrea
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.
authors: Vischioni
authors: V
authors: Barbara
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.
authors: Panizza
authors: P
authors: Denis
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.
authors: Fiore Maria
authors: FM
authors: Rosaria
authors: Department of Radiation Oncology, European Institute of Oncology (IEO), Milan, Italy.
authors: Fossati
authors: F
authors: Piero
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.
authors: Vitolo
authors: V
authors: Viviana
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.
authors: Iannalfi
authors: I
authors: Alberto
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.
authors: Ciocca
authors: C
authors: Mario
authors: IRCCS Policlinico San Matteo Foundation, Department of Onco-Hematology, Oncology Section, Pavia, Italy.
authors: Silvia
authors: S
authors: Brugnatelli
authors: Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.|IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy.
authors: Dominioni
authors: D
authors: Tommaso
authors: Department of Surgical Science, University of Parma, Parma, Italy.
authors: Dario
authors: D
authors: Bugada
authors: Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.|IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy.
authors: Maestri
authors: M
authors: Marcello
authors: Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.|IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy.
authors: Alessiani
authors: A
authors: Mario
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.
authors: Valvo
authors: V
authors: Francesca
authors: Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.|Department of Radiation Oncology, European Institute of Oncology (IEO), Milan, Italy.
authors: Orecchia
authors: O
authors: Roberto
authors: Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.|IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy.
authors: Dionigi
authors: D
authors: Paolo
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D000328:Adult; D001672:Biocompatible Materials / Q000528:radiation effects; D002817:Chordoma / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D058733:Hand-Assisted Laparoscopy; D063193:Heavy Ion Radiotherapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012447:Sacrum; D012826:Silicone Elastomers / Q000528:radiation effects; D013125:Spinal Neoplasms / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D012826:Silicone Elastomers
keywords: Carbon ion radiotherapy; Chordoma; Spacer placement