Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India.
Neurol India. 2020 Jan-Feb;68(1):42-44. doi: 10.4103/0028-3886.279680.
Chordoma and chondrosarcoma are locally aggressive tumors occurring in one-third cases at the base of the skull. These tumors often recur locally with significant morbidity and mortality. The mainstay of treatment is maximal safe tumor debulking. However, in spite of gross total resection, these tumors are likely to recur. Hence, adjuvant radiation is provided to reduce the risk of local recurrence and to improve outcomes. These tumors are considered relatively radioresistant; hence, high doses of radiation are generally required during treatment. However, the presence of several important structures around the lesion poses a major challenge with respect to covering the target with the prescribed high dose. In this regard, protons, for their physical and dosimetric advantages, have become the accepted modality of treatment in these tumors. With the evolution of proton beam therapy (PBT) over the years, especially pencil beam scanning techniques; which result in an extremely high conformal intensity-modulated proton beam therapy (IMPT), robust and Monte Carlo optimization, computational algorithms, and biological modelling are the significant advances which have further enhanced the value of this technology and have improved outcomes. Herein, we would like to report our experience of two cases of skull base tumors treated with intensity-modulated proton therapy at our center along with a review of the literature.
脊索瘤和软骨肉瘤是局部侵袭性肿瘤，1/3 发生在颅底。这些肿瘤常局部复发，导致严重的发病率和死亡率。治疗的主要方法是最大限度地安全切除肿瘤。然而，尽管进行了大体全切除，这些肿瘤仍有可能复发。因此，辅助放疗可降低局部复发风险，改善预后。这些肿瘤被认为具有相对的放射抵抗性，因此，治疗过程中通常需要给予高剂量的放疗。然而，由于病变周围存在几个重要的结构，用规定的高剂量覆盖靶区是一个主要的挑战。在这方面，质子因其物理和剂量学优势，已成为这些肿瘤的公认治疗方式。随着质子束治疗（PBT）多年来的发展，特别是笔形束扫描技术，可实现极高的适形强度调制质子束治疗（IMPT），强大的和蒙特卡罗优化、计算算法和生物学建模等技术的进步，进一步提高了这项技术的价值，并改善了预后。在此，我们报告了在我们中心用强度调制质子治疗治疗的两例颅底肿瘤病例的经验，并对文献进行了回顾。
