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Chordoma e Radioterapia
Piero FOSSATI
Milano 22 Novembre 2015
Dose
•  Chordomaisnoteasyto •  Nonèfaccile
killwithradia8on
distruggereilcordoma
conleradiazioni
•  Toachievelocalcontrol
highdosesareneeded •  PeroCenereilcontrollo
localedellmalaDa
servonodosielevate
Thereisdoseresponsecurve
Esiste una curva dose risposta
5 - year Local Control rates (%)
Protons
Munzenrider
Ares
Hug
100
1999
2009
1999
C-Ions
80
Schulz-Ertner
Mizoe - NIRS
Particles
60
Photons
40
Bugoci
Romero
Zorlu
Debus
20
20
40
60
80
2012
1993
2000
2002
100
Dose Gy (RBE)
1
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Tossicità/Toxicity
•  Chordomaarisesnear
•  Ilcordomaorigina
tocri8calorgans:
vicinoadorganicri8ci:
brainstem,op8c
troncoenceflaico,
chiasm,spinalcord
chiasmaoDco,midollo
spinale
•  Anadvancedhighly
conformalRTtechinque •  Serveunatecnicadi
isneeded
radioterapiasofis8cata
edaltamente
conformazionale
Skullbase/basicranio
Goldstandard
•  maximumsafesurgical •  massimaresezione
debulking+post
chirurgicaoCenibile
opera8veRT
senzarischi+
radioterapia
•  Protontherapy>72Gy
postoperatoria
[RBE]withconven8onal
frac8ona8on(1.8–2Gy •  Protonterapiaadosi>d
[RBE])
72Gy[RBE]con
frazionamento
convenzionale(1.8–2
Gy[RBE])
Largeconsensus/largoconsenso
•  Mixedphotons/protons •  TraCamentomisto
fotoni/proton
•  Carbonionswith
moderate
•  Ionicarboniocon
hypofrac8ona8on(3-4
ipofrazionamento
Gy[RBE])
moderato(3-4Gy
[RBE])
•  Stereotac8cphotons
RTinselectedcaseand •  RTstereotasscacon
ifpaer8clesarenot
fotoniincasiseleziona8
available
eselepar8cellenon
sonodisponibili
2
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Openissues/pun8aper8
•  Cancarbonions
compensatefor
macroscopicresidual
disease?
•  Isthereasubsetof
pa8entsthatcanavoid
postopRT?
•  E’possibilecompensare
lapresenzadiresiduo
macroscopicomediante
iltraCamentoconuioni
carbonio?
•  EsisteunsoCoinsieme
dipazien8chepuò
evitarelaRTpost
operatoria
Sacrum/sacro
Goldstandard
•  Radicalsurgerywith
clearmargins
Or
•  Surgery+post
opera8veRTif
infiltratedsurgery
Or
•  Exclusivepar8cle
therapy
•  Chirurgiaradicalecon
marginipuli8
Oppure
•  Chirurgia+RTpost
operatoriasemargini
infiltra8
Oppure
•  Radioterapiacon
par8celleesclusiva
Openissues/pun8aper8
•  Doweneedadjuvant
RTaherradical
resec8onwithclear
margins?
•  ServelaRTpost
operatoriadopo
chirurgiaradicalecon
marginipuli8?
3
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Mobilespine/colonnamobile
Goldstandard
•  Radicalsurgerywith
clearmargins
Or
•  Separa8ngsurgery+
postopera8veRT
Or
•  Sandwitch:RTà
surgeryàRT
•  Chirurgiaradicalecon
marginipuli8
Oppure
•  Chirurgiadiseparazione
+RTpostoperatoria
Oppure
•  Sandwitch:RTà
chirurgiaàRT
Mobilespine/colonnamobile
openissues
•  Canweusestabiliza8on •  Possiamousare
deviceswithoutmetal?
strumentazionenon
metallicaperla
stabilizzazionedella
colonna?
4