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Case report
peer-reviewed

Dramatic Response of a Large Sacral Chordoma to Intensity Modulated Proton Beam Therapy



Abstract

Sacral chordomas are slow-growing, indolent, and locally invasive tumors that typically present with pain and neurologic dysfunction. Wide en-bloc surgical excision is the primary treatment, but achieving adequate margins is difficult and surgery is often associated with significant morbidity. Adjuvant radiation therapy (RT) is utilized to decrease the risk of local recurrence or as definitive treatment for nonsurgical candidates. Although chordomas are considered to be relatively radioresistant tumors, several studies have demonstrated tumor response to high-dose proton therapy. Here, we present a patient with a large sacral chordoma who underwent definitive treatment with intensity-modulated proton therapy (IMPT).



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Case report
peer-reviewed

Dramatic Response of a Large Sacral Chordoma to Intensity Modulated Proton Beam Therapy


Author Information

Craig Schneider

Radiation Oncology, University of Maryland School of Medicine

Melissa Vyfhuis Corresponding Author

Radiation Oncology, University of Maryland School of Medicine

Emily Morse

Radiation Oncology, University of Maryland School of Medicine

Tejan Diwanji

Department of Radiation Oncology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

Sina Mossahebi

Radiation Oncology, University of Maryland School of Medicine

Katarina Steacy

Radiation Oncology, University of Maryland Medical Center

Robert Malyapa

Radiation Oncology, University of Maryland School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Dramatic Response of a Large Sacral Chordoma to Intensity Modulated Proton Beam Therapy


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Case report
peer-reviewed

Dramatic Response of a Large Sacral Chordoma to Intensity Modulated Proton Beam Therapy

  • Author Information
    Craig Schneider

    Radiation Oncology, University of Maryland School of Medicine

    Melissa Vyfhuis Corresponding Author

    Radiation Oncology, University of Maryland School of Medicine

    Emily Morse

    Radiation Oncology, University of Maryland School of Medicine

    Tejan Diwanji

    Department of Radiation Oncology, University of Maryland Medical Center

    James W. Snider

    Radiation Oncology, University of Maryland School of Medicine

    Sina Mossahebi

    Radiation Oncology, University of Maryland School of Medicine

    Katarina Steacy

    Radiation Oncology, University of Maryland Medical Center

    Robert Malyapa

    Radiation Oncology, University of Maryland School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: September 10, 2017

    DOI

    10.7759/cureus.1670

    Cite this article as:

    Schneider C, Vyfhuis M, Morse E, et al. (September 10, 2017) Dramatic Response of a Large Sacral Chordoma to Intensity Modulated Proton Beam Therapy. Cureus 9(9): e1670. doi:10.7759/cureus.1670

    Publication history

    Received by Cureus: June 19, 2017
    Peer review began: June 21, 2017
    Peer review concluded: September 07, 2017
    Published: September 10, 2017

    Copyright

    © Copyright 2017
    Schneider et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Sacral chordomas are slow-growing, indolent, and locally invasive tumors that typically present with pain and neurologic dysfunction. Wide en-bloc surgical excision is the primary treatment, but achieving adequate margins is difficult and surgery is often associated with significant morbidity. Adjuvant radiation therapy (RT) is utilized to decrease the risk of local recurrence or as definitive treatment for nonsurgical candidates. Although chordomas are considered to be relatively radioresistant tumors, several studies have demonstrated tumor response to high-dose proton therapy. Here, we present a patient with a large sacral chordoma who underwent definitive treatment with intensity-modulated proton therapy (IMPT).



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Create a free account to continue reading this article.

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Craig Schneider

Radiation Oncology, University of Maryland School of Medicine

Melissa Vyfhuis

Radiation Oncology, University of Maryland School of Medicine

For correspondence:
mvyfhuis@umm.edu

Emily Morse

Radiation Oncology, University of Maryland School of Medicine

Tejan Diwanji

Department of Radiation Oncology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

Sina Mossahebi

Radiation Oncology, University of Maryland School of Medicine

Katarina Steacy

Radiation Oncology, University of Maryland Medical Center

Robert Malyapa

Radiation Oncology, University of Maryland School of Medicine

Craig Schneider

Radiation Oncology, University of Maryland School of Medicine

Melissa Vyfhuis

Radiation Oncology, University of Maryland School of Medicine

For correspondence:
mvyfhuis@umm.edu

Emily Morse

Radiation Oncology, University of Maryland School of Medicine

Tejan Diwanji

Department of Radiation Oncology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

Sina Mossahebi

Radiation Oncology, University of Maryland School of Medicine

Katarina Steacy

Radiation Oncology, University of Maryland Medical Center

Robert Malyapa

Radiation Oncology, University of Maryland School of Medicine