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

Abstract

Chordomas are rare malignant neoplasms arising fromvestigial remnants of the embryonic notochord.Approximately 55-70% of chordomas develop within thevertebral column. Their affinity to develop within the bonesof the axial skeleton and propensity to locally invade andrecur makes them challenging candidates for completesurgical excision. Adjuvant therapies are hence necessaryto improve outcomes; for which chemotherapy has beenobserved to be largely ineffective, owing to the tumourbeing resistant to it. Radiotherapy is the current adjuvanttherapy of choice for chordoma management. Over theyears, proton beam therapy (PBT) has been the subject ofmedical attention, given the dosimetric benefits it confersover traditional radiotherapy, allowing more concentratedradiation to be given to the target of interest and reducingdamage to surrounding normal tissue. A review of thecurrent literature reveals PBT offers significantly betteroutcomes when used as an adjuvant to maximal surgicalresection rather than as a definitive therapy.Keywords: Chordoma, Proton Beam Therapy, Outcome,Recurrence, Spinal, Adjuvant Therapy