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Specialist treatments    <    Proton therapy    <    Skull base tumours

Proton Therapy for Skull Base Tumours

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Proton Therapy for Skull Base Tumours

NOTE: The following text is provided courtesy of ProCure Treatment Centers Inc. Links to published papers have been removed but are available on request, wherever * is indicated.
Clinical indication: skull base tumours
Although often slow-growing, chordomas and chondrosarcomas present complex challenges in clinical management.
They often impinge upon the brain stem or spinal cord and can invade central nervous system tissue. In general, it is not possible to completely resect the tumour with adequate margins.
The location also often limits the dose of standard X-ray radiation that can be delivered and the results of conventional treatment are suboptimal.
The relative ease of patient immobilisation and shallow tumour depths make base-of-skull tumours amenable to treatment with proton therapy. Protons deliver a high dose while avoiding damage to healthy brain or spinal cord tissues.* The local tumour control rates for proton therapy are reported to be higher than for X-ray radiotherapy in these regions.*
Noël, et al studied 51 patients with intracranial benign meningiomas in the base of the skull, who were treated with a combination of photon and proton radiation therapy.
Results showed excellent local tumour control and functional outcome with a low risk of treatment-related morbidity.
This study demonstrated that the combination of protons and photons is a safe and effective therapeutic option for patients with benign meningioma in the base of skull.*
In addition, a study of 27 patients with intracranial meningiomas concluded that proton therapy is the best choice for controlling large and complex-shaped base-of-skull meningiomas.*
Proton therapy has also demonstrated effectiveness in treating vestibular schwannomas with relatively few complications.*
A comparison of radiation treatment plans for a base-of-skull clivial chordoma.
Source: ProCure Training and Development Center
In the treatment plans shown (click to enlarge), the proton therapy plan shows the spinal cord receiving less radiation and the jaw receiving none at all.
With the X-ray/IMRT plan, more healthy tissue receives radiation. The coloured area in the rightmost image shows the excess radiation that IMRT/X-rays deliver.
Proton therapy for skull base tumours
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Proton Therapy for Skull Base Tumours

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Comparison of radiation treatment plans for a base of skull clivial chordoma