Radiation for chordoma
The purpose of radiation therapy is to kill or stop the growth of tumor cells within the body. Below is information about how radiation can be used for the treatment of chordoma.
Role of radiation
Radiation can serve different roles in the treatment of chordoma, which can vary based on the stage of the disease.1 2
Newly diagnosed chordoma
- Reduce the risk of Tumor that has grown back after initial treatment. Recurrences can be isolated or multifocal, local or regional.: Radiation is usually recommended after surgery to kill any remaining tumor cells that are left behind in your body after surgery. In some cases, radiation is given both before and after surgery. This method is typically used for sacral tumors and sometimes The parts of the spine not including the sacrum. The cervical spine (neck), thoracic spine (upper back), and lumbar spine (lower back) are the parts of the mobile spine. tumors.
- Main treatment instead of surgery: Radiation is sometimes recommended as the primary treatment following a A procedure that uses a needle to remove a small tissue sample from the tumor to be tested in order to make a diagnosis. if the tumor cannot be removed with surgery or if the risks of surgery are unacceptable to you.
- Curative treatment: If you experience a recurrence and are able to receive high-dose radiation, radiation with or without surgery is an option. In some cases, high-dose radiation can be given for recurrent tumors as part of a treatment plan with Treatments that are given for the purpose of curing a disease or providing long-term survival..
- Palliative treatment: If you cannot have high-dose radiation, a lower dose may be given to help slow the growth of the recurrent tumor and ease symptoms you might be experiencing.
Advanced or metastatic disease
- Treatment for individual tumor sites: If your tumor has spread to other areas of your body, radiation can sometimes be given to one or more of the tumors in those areas.
- In combination with The use of drugs that spread through the body to kill cancer cells. Also called chemotherapy or drug therapy.: Radiation helps stimulate the immune system to cause it to kill cancer cells, which may help some systemic therapies work better. The combination of radiation and systemic therapies is currently being studied in clinical trials for chordoma.
- Palliative treatment: Low-dose radiation can be used to help slow tumor progression and ease any symptoms you might be experiencing.
There are different types of radiation and different ways radiation can be given to treat chordoma.
External beam radiation
Chordomas are generally treated with a beam of radiation that is delivered to the tumor from a source outside of the body. This is called Radiation that is delivered from outside the body..
Proton beam and carbon ion
Radiation with beams of charged particles, called A type of external beam radiation that uses beams of protons, neutrons, or positive ions for the treatment of cancer., is generally recommended for treating chordoma because it can be focused very precisely on the tumor.1
Two different types of particles are commonly used: protons and carbon ions. These are usually referred to as proton therapy or A type of particle therapy that uses beams of protons to kill cancer cells., and A type of particle therapy that uses beams of charged carbon ions to kill cancer cells. Carbon ion therapy can deliver high doses of radiation to a tumor while sparing surrounding normal tissue.. It is not yet known whether there is any difference in effectiveness between protons and carbon ions.
Proton and carbon ion treatment centers are very expensive to build, so they do not exist at every medical institution. Proton centers are becoming more common, with centers in the United states and several countries throughout Europe and Asia. Currently, carbon ion therapy is only available in Austria, China, Germany, Italy, and Japan.
A type of external beam radiation that uses x-rays to kill cancer cells. radiation
In some cases, highly focused photon radiation can be a suitable alternative to particle therapy as long as a high enough dose can be delivered without damaging healthy tissue. Intensity modulated radiation therapy (A type of radiation that uses computer assistance to deliver beams of radiation to a specific location in the body. Also called IMRT.) is one type of photon radiation that may be used.
A type of external beam radiation that uses special equipment to position a patient and precisely deliver radiation to tumors in or near the brain, over a small number of treatments. (SRS) and A type of external beam radiation that uses special equipment to position a patient and precisely deliver radiation to tumors in all parts of the body except the brain, over a small number of treatments. (SBRT) are types of hypofractionated radiation, which may make them important options for recurrent or advanced chordoma. When A radiation treatment technique that gives larger doses of radiation over a smaller number of sessions. The total amount of radiation given is less than when standard fractionation is used, but the effect is the same. is used the total amount of radiation given is less than when standard fractionation is used, but the effect should be the same.5
Sometimes it may be helpful to combine particle therapy and photon radiation. For all types of external beam radiation, imaging is needed every day of treatment to make sure that the radiation is going to exactly the right place. This technique is called The use of frequent imaging, such as MRI or CT, during radiation treatments to help direct the radiation to the right place..
Another method of delivering radiation, called A type of radiation therapy in which a small amount of radioactive material is placed inside the body to kill cancer cells., involves inserting a small amount of radioactive material inside the body during surgery. This method is not used very often for chordoma, but can sometimes be helpful for delivering a high enough dose of radiation to the area near the The brainstem is the lower part of the brain connected to the spinal cord. The brainstem relays all signals to and from the brain and the body and is responsible for maintaining consciousness, breathing, and heartbeat. or spinal cord. When used, it is usually given in combination with external beam radiation.1
Dose of radiation
What matters most about radiation for chordoma is that chordomas require very high doses of radiation to be controlled. Specifically, a total dose of at least 74 The abbreviation for gray equivalents, which refers to the unit of measurement for an absorbed dose of radiation. (Grey Equivalents) is recommended for proton and photon radiation. If the entire tumor has been removed, the dose of radiation to the areas surrounding where the tumor was can sometimes be limited to 70 GyE.1 2
Once you have been treated with a high dose of radiation, it might not be possible for you to have radiation again. If your tumor comes back after your first treatments, the option of further radiation will depend on factors such as the location of the new tumor growth and how long it has been since the previous dose of radiation. Hypofractionated radiation like SRS and SBRT can sometimes make it possible to have further radiation.
Lower doses of radiation are sometimes given to help slow the growth of recurrent or advanced tumors and ease symptoms like pain and nerve damage. Radiation may also be given along with systemic therapies to help increase their effectiveness.2
Any time you are considering treatment it is a good idea to talk with your medical team about the role that radiation therapy should play in your treatment.
To help you find the best care possible we have organized a list of chordoma experts that you can search by specialty, location, and key terms.
Before you begin radiation treatments, you will visit with the radiation oncologist. The doctor will discuss your treatment plan with you, including what side effects you might expect from the treatments. If you have a The bones at the bottom part of the skull that separate the brain from other structures. The clivus is one of the bones of the skull base. or The seven vertebrae that make up the neck. These vertebrae are commonly referred to as C1-C7. tumor, radiation technicians will fit you for a mask that will be used to stabilize your head and neck during the treatments. Something similar may also be done if your tumor is on the The twelve vertebrae of the upper and mid back, extending from the shoulders to the bottom of the rib cage. These bones are commonly referred to as T1-T12., The five vertebrae of the lower back, commonly referred to as L1-L5., or sacral spine.
The radiation technicians will see you at each visit. You may need to remove certain parts of clothing and then the tech will have you lay down on a special table, called a A special type of table used during radiation treatments. The couch can be moved in many different directions in order to accurately position the patient for treatment. If anything is being used to stabilize part of the body for treatment, it is usually attached to the treatment couch., which is used to accurately position you. If you have a mask, the technician will attach your mask to the treatment couch. This can cause some patients to feel anxious or claustrophobic. If this happens to you, ask your technicians about things other patients have found helpful in dealing with this feeling.
Proton beam, carbon ion, and IMRT photon radiation are typically given in small doses during daily sessions (usually around 35-40) over 6-8 weeks. The dose of radiation delivered during each session is called a The dose of radiation delivered during one session of radiation therapy.. The radiation from each fraction accumulates over time until the total dose is reached. The treatments themselves last just a minute or two.3 6 7
Hypofractionated radiation like SRS and SBRT are given in larger doses over a shorter amount of time (usually 1-5 sessions). This is called hypofractionation. The treatments themselves can last an hour or more, depending on how many sessions are being done.5
During treatment, you will have a check-up with your radiation oncologist every few weeks. After you complete all radiation treatments, your doctors will likely recommend waiting 2-3 months before doing imaging to allow time for any swelling or inflammation that might have been caused by the treatments to subside.
The amount of radiation required to treat chordoma is higher than what healthy tissue can handle. For this reason, it is important for the radiation dose to be focused on the tumor while avoiding important nearby structures such as the brain, brainstem, nerves, or spinal cord. However, even with highly focused radiation like proton beam or carbon ion therapy, short- and long-term side effects are still possible.
Short-term side effects that you might experience during radiation treatments can vary depending on the location of your tumor. A rash and skin irritation at the site of radiation are very common for all patients. Your care team can suggest types of lotion or cream that can help protect your skin and soothe irritation. Nausea and fatigue are experienced by most patients at some point during radiation treatments. Other side effects that might be experienced are listed below.4 7
Skull base patients
Mobile spine patients
Despite these possible side effects, most patients receiving radiation say they feel good enough to continue daily activities. Patients having proton beam therapy who move temporarily to where the proton center is located often enjoy outings and sightseeing in the local area.
Most of these side effects will resolve after radiation ends. However, some can remain for many months or be permanent. You may also experience “late” effects of radiation, meaning they do not begin until months or years after radiation ends.4 These can include issues with endocrine system function; changes to hearing, vision, or swallowing; bowel, bladder, or sexual issues; and Chronic pain caused by nerve damage. including pain, weakness, and numbness in the face or extremities.
Talk with your radiation oncologist about the risks involved in your radiation treatment plan.
Follow-up after treatment
Following any treatment for chordoma, it is very important to maintain a regular schedule of MRIs and checkups with your doctor. These follow-ups will monitor your recovery, assess ongoing quality of life needs, as well as check for new tumor growth.
To help you get the best care possible, we developed lists of questions with the input of chordoma patients and caregivers that can help you think about what you want to ask your doctors.
References and further information
The information provided herein is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your or your loved one’s physician about any questions you have regarding your or your loved one’s medical care. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website.