[en] Thirty patients were evaluated with CT (five also underwent MR imaging). The location, extent, and imaging patterns are described in detail. The results of the study are as follows: chondrosarcomas in the base of skull occur most often in the sphenoid bone, including the sphenoid sinus and clivus; calcifications were present in 75% of cases; CT demonstrated calcifications optimally, while MR imaging defined the boundary of the tumor to better advantage, especially the intracranial component; chrondrosarcoma with tumor calcification cannot be differentiated from osteogenic sarcoma or chordoma; and the grade of malignancy is not related to calcification in head and neck chondrosarcomas compared with peripheral chondrosarcomas

[en] In 60 chordomas of the head and neck, CT and MR findings are compared and analyzed for sensitivity in the detection of tumor, accuracy in delineation of the extent of tumor, and characterization of tumor matrix. The findings are as follows: chordomas often attain diameters of >1-2 cm before they are diagnosed; CT and MR imaging are equal in detecting these lesions; CT is superior to MR imaging for showing bone destruction and tumor calcification; and MR signal intensities (T1, T2, proton) are nonspecific in characterizing the lesion, and T1 and T2 values are prolonged in the tumor tissue

[en] Purpose: To report neurologic sequelae and clinical outcome for local recurrence free-survival and overall survival of patients treated with high-dose fractionated radiation therapy utilizing 3D treatment planning and combined proton and photon beams to portions of the cauda equina (L2-Coccyx), and to reassess tolerance of this structure to therapeutic radiation. Materials and Methods: From 1974 through 1994, 62 patients were treated to fields encompassing portions of the cauda equina, of whom 55 were evaluable; this cohort is the study group. Pathology included 37 sarcomas, 17 chordomas, 3 desmoid tumors, 2 ependymomas, 2 adrenocortical carcinomas and 1 squamous cell carcinoma of the cervix. 29 patients were male; 26 were female. Median prescribed dose was 66.59 CGE (Cobalt Gray Equivalent: proton Gy x RBE1.1 + photon Gy), ranging from 42.00-82.00 CGE. 3D CT treatment planning has been used in all patients treated since 1980. Median follow up was 44 months (range 1.5-168 months). Neurologic status was assessed by retrospective chart review. Dose volume histograms are available and will be compared with risk of neurologic side effects. Results: Treatment outcome was evaluated for local recurrence, radiation complication-free survival (both assessed at last living follow up) and absolute survival. 18 patients expired, 37 were alive at last follow up. Overall survival at 3 years was 81% and at 5 years 70%. At last living follow up, 29 patients were NED, 5 had local failure, 7 distant metastases, 7 local failure and distant metastases, 5 local symptoms, recurrence possible, and 2 were alive, disease status undetermined. Neurologic status at last living follow up: 3 patients had probable radiation complications, 5 had pain, which may represent radiation complications, and 8 were neurologically impaired secondary to their disease. Including the 5 pain patients as RT complications, the radiation complication-free survival of evaluable patients at 3 years was 95% and at 5 years was 76%. Conclusion: These data suggest that the tolerance of the cauda equina to radiation therapy may be greater than has been generally accepted. Local failure remains a significant problem in these diseases, as does metastatic spread

[en] The treatment of 317 patients treated either wholly or in part with proton beams at the Harvard Cyclotron Laboratory is reported. These include: 130 patients treated for definitive radiation therapy of choroidal melanoma; 17 patients treated for tumors of the base of skull, cervical spine and cranium, which abut structures of the central nervous system (CNS); 23 patients treated for sarcomas of soft tissue and bone; 65 patients treated for carcinoma of the prostate; 14 patients treated for carcinoma of the rectum and anus; and 23 patients treated for squamous carcinoma of the oral cavity and oro-pharynx. Data on causes of failure and morbidity of treatment are presented. Overall the results are judged to be extremely encouraging. In particular, the treatment of the choroidal melanomas and sarcomas abutting CNS structures have clear clinical value, and the treatment of prostatic tumors and tumors of the head and neck are thought to be promising

[en] The treatment of 317 patients treated either wholly or in part with proton beams at the Harvard Cyclotron Laboratory is reported. These include: 130 patients treated for definitive radiation therapy of choroidal melanoma; 17 patients treated for tumors of the base of skull, cervical spine and cranium, which abut structures of the central nervous system (CNS); 23 patients treated for sarcomas of soft tissue and bone; 65 patients treated for carcinoma of the prostate; 14 patients treated for carcinoma of the rectum and anus; and 23 patients treated for squamous carcinoma of the oral cavity and oro-pharynx. Data on causes of failure and morbidity of treatment are presented. Overall the results are judged to be extremely encouraging. In particular, the treatment of the choroidal melanomas and sarcomas abutting CNS structures have clear clinical value, and the treatment of prostatic tumors and tumors of the head and neck are thought to be promising

[en] Purpose/Objective: To review the outcome of patients with vestibular schwannomas treated with stereotactic proton irradiation, both single-fraction and fractionated, in order to establish comparative disease-control rates and morbidities. Materials and Methods: All available records of 31 patients treated with 160 MeV proton irradiation between 1976 - 1990 were reviewed. 19 patients (10 females and 9 males) had unilateral lesions, 12 patients (9 females and 3 males) had neurofibromatosis II. In the NF group the indication to treat was to preserve hearing in 10 patients, while in the non-NF group, the indication to treat in 4 patients was post-surgical recurrence and in 6 was post-operative residual. Treatment techniques were consistent in that 25 patients were treated by one physician with a single fraction of proton irradiation. 6 patients were treated with fractionated irradiation with a combination of 160 MeV protons and 3-D planned megavoltage photons. The mean dose given to the 90% isodose line (encompassing tumor) for single-fraction treatments was 31.4 CGE, with an average target volume of 3.8 cc. The fractionated doses varied from 57.1 to 72.0 CGE delivered at 1.7-1.9 CGE/day. The mean proton component in the fractionated treatments was 72%. Mean tumor diameter in the single-fraction NF group was 2.6 cm and in the non-NF group was 2.4 cm. For the fractionated group mean diameter was 2.3 cm. Results: With a median follow-up of 10.6 years (range 0 - 19), the 1, 5, 10, and 18-year overall actuarial survivals of the group with NF were 91, 82, 63 and 42%, respectively. For non-NF group the same interval actuarials were 100, 100, 94 and 63%, respectively. Actuarial event-free survival (clinical/radiological progression or surgical intervention) for the patients treated with NF was 54% at 1 year and remained at 46% from 5 to 18 years. For the group with no NF, the 1, 5, and 10-year event-free survivals were 73%, 67%, and 58%, respectively. The differences between the two groups' survivals are not statistically significant. Analysis of hearing preservation indicates those patients with NF to have maintained useful hearing in 22% of cases - loss of serviceable hearing occurred either due to irradiation or to tumor progression, requiring surgery and consequent CN 8 resection. Of the non-NF patients, only 25% of those with pre-treatment useful hearing (n=4) retain hearing. Comparison of irradiation regimens indicates rates of hearing preservation to be 30-40% by single-fraction and 50-60% by fractionated technique. Facial nerve complication rates indicate in the NF group a 16% permanent deficit rate, due to probable progression of tumor in all patients. In the non-NF patients, temporary CN 7 palsy occurred in 50%, with permanent deficits occurring in 16% due to tumor progression and another 16% due to irradiation damage. Single-fraction and fractionated irradiation permanent CN 7 deficit rates are 15-40% and 0-10%, respectively. Trigeminal nerve palsies occurred in 3% of patients transiently and 6% permanently after irradiation, with all patients having received fractionated treatment. Of the patients with permanent CN 5 deficits, 50% had NF. Transient edema was noted radiologically in 3 patients, 1 with NF. There were no reported cases of acute hydrocephalus after the irradiation, although 15 of the 31 had distortion of the fourth ventricle prior to irradiation. Ataxia was present initially in 28 patients and worsened with time in 22%. Conclusions: The long-term follow-up of this mixed population of NF/non-NF acoustic neuroma patients suggests similar survival/complication rates to other surgical/irradiation techniques. Surprisingly, the relatively high doses used in this early single-fraction effort did not realize either improved control or worse complication rates compared to more contemporary series

[en] The endocrine status of patients receiving proton radiation for tumors of the upper clivus was reviewed to evaluate the effect of high dose treatment on the pituitary gland. The fourteen patients had chordomas or low grade chondrosarcomas and were all treated by the same techniques. The median tumor dose was 69.7 Cobalt Gray Equivalent (CGE) with a range from 66.6 to 74.4 CGE. (CGE is used because modulated protons have an RBE of 1.1 compared to 60Co). The daily fraction size was 1.8-2.1 CGE. The median follow-up time is 48 months, ranging from 30 to 68 months. All treatments were planned using a computerized multi-dimensional system with the position of the pituitary outlined on the planning CT scan. Review of the dose distribution indicated that the dose to the pituitary ranged from 60.5 to 72.3 CGE, with a median of 67.6 CGE. One female patient had decreased thyroid and gonadotropin function at the time of diagnosis and has been on hormone replacement since that time. The other three females were all pre-menopausal at the time of radiotherapy. At this time four patients (3 males and 1 female) have developed endocrine abnormalities 14 to 45 months after irradiation. All four had evidence of hypothyroidism and two have also developed corticotropin deficiency. The three males had decreased testosterone levels; the female patient developed amenorrhea and hyperprolactinemia. All four are asymptomatic with ongoing hormone replacement

[en] The incidence of metastasis and prognostic factors for metastasis in 780 consecutive patients with uveal melanomas treated with proton beam irradiation were evaluated. Metastasis developed in 64 patients (8%). The median time from treatment to the diagnosis of metastasis was 2.1 years (range, 3 months to 7.3 years). The liver was primarily involved in 58 (90%) patients. The 5-year cumulative probability of metastasis developing was 20%. Prognostic factors for metastasis developing were quite comparable to those found for patients treated by enucleation and included largest tumor diameter, involvement of the ciliary body, older age, and extrascleral extension. Surgical localization, tumor height, and elevated liver enzymes before treatment were not important factors in the development of metastasis

[en] Short communication

[en] Proton beam irradiation has been used for the treatment of 241 uveal melanomas over the past 7 1/2 years. Twelve melanomas (5%) were small, 99 (41%) medium, 103 (43%) large and 27 (1%) extra-large melanomas. The mean length of follow-up was 21 months and the median 15 months. Ninety-four percent of the treated lesions with a follow-up more than two years and 65% of tumors with shorter follow-up showed regression. The most recent visual acuity was 20/40 or better in 47% and 20/100 or better in 66%. Ten eyes were enucleated because of complications (9) or continued tumor growth (1). Thirteen patients developed metastases from 4 to 50 months of treatment. Our data indicate that proton irradiation can be used to treat melanomas of various sizes and in a variety of locations, and preliminary results suggest that proton therapy has no deleterious effect on the likelihood of the development of metastases