Role of Proton Beam Therapy in Spinal Chordomas: A Narrative Review of The Literature

Abstract

Chordomas are rare malignant neoplasms arising from
vestigial remnants of the embryonic notochord.
Approximately 55-70% of chordomas develop within the
vertebral column. Their affinity to develop within the bones
of the axial skeleton and propensity to locally invade and
recur makes them challenging candidates for complete
surgical excision. Adjuvant therapies are hence necessary
to improve outcomes; for which chemotherapy has been
observed to be largely ineffective, owing to the tumour
being resistant to it. Radiotherapy is the current adjuvant
therapy of choice for chordoma management. Over the
years, proton beam therapy (PBT) has been the subject of
medical attention, given the dosimetric benefits it confers
over traditional radiotherapy, allowing more concentrated
radiation to be given to the target of interest and reducing
damage to surrounding normal tissue. A review of the
current literature reveals PBT offers significantly better
outcomes when used as an adjuvant to maximal surgical
resection rather than as a definitive therapy.
Keywords: Chordoma, Proton Beam Therapy, Outcome,
Recurrence, Spinal, Adjuvant Therapy