* From the Radiation Therapy Division of the Department of Radiology, University Hospital (New York University School of Medicine), and the Radiation Therapy Department, Hospital for Joint Diseases Medical Center, New York, New York. VOL. io8, No. 2 JJ RADICAL RADIATION THERAPY OF CHORDOMA* By ALEXANDER W. PEARLMAN, M.D., and MILTON l”RIEDMAN, M.D. NEW YORK, NEW YORK T HIS study was undertaken to evaluate the role of irradiation in the treatment of chordoma. It is based on the authors’ I5 patients treated with a combination of massive dose radical irrad!iation and stir- gery, and an analysis of the rac!iation data from 81 reported patients treated pri_ manly with irradiation. Cures with surgery alone are not too common because the large size and critical location of most lesions make total re- moval difficult, and the consequent nor- mal tissue deficit severely crippling. Cures with radiation alone are even rarer because the tumor is so radioresistant that the required tumor lethal dosage is capable of severe injury to normal tissues and must be administered with sophisticated techniques. The typical average patient with chor- doma lives for many years with a succession of increasingly grave local recurrences. Useful palliation and an occasional cure depend on combined irradiation and sur- gery, combined properly for each case, providing that the irradiation is radical. Approximately one-half of chordomas originate in the sacrum and coccyx and one-third in the basi-sphenoid region. The remaining occur in the cervical or lumbar spine. Chordomas grow slowly but are locally aggressive, destroying bone, infil- trating the soft tissues and often attaining considerable size before the diagnosis is established. In planning treatment, the fo!- lowing considerations are pertinent: Com- plete excision is rarely possible due either to the extent of the tumor or to its inac- cessible location, (basi-sphenoid) ;4 ade- quate treatment is hampered by the close proximity of the tumor to the brain and spinal cord; and in any treatment plan, consideration must be given to the high probability of local recurrence following surgery or irradiation. The clinical course of our i patients is summarized in Table I. Seven patients survived! longer than years. Seven, in- cluding 2 patients with basi-sphenoid tumors, (lid! not benefit significantly from treatment, the longest survival in the latter group being 3 1/2 years. One patient, alive with disease, is at risk for only i 1/2 years. Some of the therapeutic problems are illustrated by the following case reports (see also Table I). REPORT OF CASES CASE 2. N.S., a white male, aged 53 years, had a presacral chordoma which was resected together with the coccyx and lower 2 sacral segments in 1960. He was asymptomatic for 3 years, when the tumor recurred. Roentgeno- grams of the sacrum revealed osteolytic defects in the third sacral segment and a colon barium enema study demonstrated a presacral mass indenting and displacing the upper rectal seg- ment (Fig. i). The recurrent tumor was irradiated in Jan- uary 1963, the maximum tumor dose being 8,320 rads in 52 days to a I2X15 cm. cylinder of high dosage irradiation, employing 2 million volt, 3600 rotation therapy. The radiation field extended from the iliac crest to the level of the anus. The presacral mass disappeared after irradiation and the osseous lesions in the third sacral segment healed. During the succeeding 2 years, there were intermittent episodes of rectal bleeding, at- tributable to radiation-induced telangiectasia of the rectal mucosa. Rigidity and tubularity of the rectosigmoid colon gradually developed as a result of radiation fibrosis. A recurrent marginal satellite tumor was re- moved from the right femoral triangle in June 1965, and another was enucleated from the left gluteus maximus muscle in December 1965. Downloaded from www.ajronline.org by 171.243.67.90 on 05/28/23 from IP address 171.243.67.90. Copyright ARRS. For personal use only; all rights reserved
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
![Sacral chordoma incidentally discovered in a patient …...regions (50%), and cervical vertebrae (10%) [2]. The annual incidence of chordoma is one in million in the United States,](https://static.cupdf.com/doc/110x72/5fc7fcd785a504193f3d25ef/sacral-chordoma-incidentally-discovered-in-a-patient-regions-50-and-cervical.jpg)
