ION RADIOTHERAPY FOR SACRAL CHORDOMAS骶骨脊索瘤的碳离子放射治疗课件.ppt

CARBON ION THERAPY FOR SACRAL CHORDOMAS Tadashi KAMADA, MD Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba, JAPAN CTOS 14th Annual Meeting November 13-15, 2008 London UK Carbon beam has a definite range and the Bragg peak.In addition to this physical selectivity, ionization is enormous at the Bragg peak, and showing biological advantages such as cell cycle independent effect. Therefore, carbon beam could be a potentially curable armament for radio-resistant tumors such as chordoma. Bragg peak Carbon ion therapy for chodoma : Background Material Surgery is the mainstay of treatment for chordomas. However, complete excision is frequently difficult in S2 or higher lesions without severe functional loss. On the other hand, chordoma shows minimal response to radiation or chemotherapy. Between 1996 and 2007, 95 patients with sacral chordoma were included in the phase I/II (Kamada, JCO 2002) and phase II (Kamada, JCO 2008) study of carbon ion therapy for bone and soft tissue sarcomas. No. of Pts : 95 sacral chordma Gender : 68 males / 27 females Age : 30 - 85(median65) Presentation : 84 primary / 11 post op rec Tumor Diameter : 3～17 cm （Median：9 cm） Tumor Volume : 47～1497 cc （Median：370 cc） (From Jun 1996 to Feb 2007) Patients Characteristics L5 10 S1 29 S2 29 S3 9 S4~ 7 Post op rec 11 Sacral Chordoma : Level of Invasion More than 80 % were S2 or higher level lesions Carbon ion therapy - all 16 Fractions over 4week Total dose: 52.8-64GyE : 2, 70.4GyE : 86, 73.6GyE : 7 (3.3-4.6GyE/fr.) Number of port : Two ports : 2 , Three ports : 91, Patch : 2 代表的なものに変更 96% 90% 50% 30% 10% With 3 ports; right-left, left-right anterior-posterior(patch) With 3 ports; right-left, left-right, posterior-anterior Carbon ion Dose Distribution in Sacral Chordoma Bowels were spared ! 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Probability 0 12 24 36 48 60 72 84 96 108