Paraspinal tumors

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Description

Paraspinal tumors occur next to the spine. These tumors are rare and correspond to chordomas, chondrosarcomas, sarcomas … They are not easily operable in general, or when they are, the surgeon may not be able to completely remove the tumor mass without inducing significant sequelae.

These tumors also have the distinction of being resistant to radiation therapy and require high radiation doses. Proton therapy, more accurate than conventional radiotherapy, can make the difference for these tumors that often lie next to healthy tissue, very sensitive to high doses of radiation.

Treatment procedure

Consultation, virtual simulation, multidisciplinary meeting

Each patient will be seen in consultation by the radiation oncologist to collect all the clinical, radiological and histological information and then present the case in multidisciplinary meeting to validate or not the indication for proton therapy.

The case can be discussed in a multidisciplinary meeting before the consultation with the radiation therapist to speed up procedures and if all the elements of the case are sufficient to make it possible.
Besides obvious clinical indication and prior consultation, a computer simulation of the treatment can be performed to assess the magnitude of the benefit of the proton treatment over a conventional radiotherapy by photons or electrons. Indeed, it may be that conventional treatment is appropriate and that proton therapy is not necessary.

A simulation CT is performed to collect the images on which the zones to treat and to avoid will be delineated. A mask is sometimes used to immobilize head lesions as to always treat them in the same position. For other targets (in the chest or abdomen, for example) we resort to a tattoo the size of a mole. Using these tattoos or marks on the mask, lasers are used to reposition to be able to readjust perfectly on the treatment area by positioning these lasers.

If chemotherapy is associated: A consultation will be held in Nice and / or in the city of origin to prescribe chemotherapy if indicated during radiotherapy.

Treatment initiation

The total dose of irradiation given is divided into multiple small doses of 1.8 to 2 Gy most of the time. These doses are delivered daily (once daily) except weekends and holidays. The total irradiation time is from several weeks (1 to 1 month and a half). The patient is seen once a week by a medical doctor, or more if necessary, to detect and treat the symptoms related to radiation. All patients will be seen by a doctor (in Nice or in the referral center) several weeks after radiation to monitor the short-term tolerance of treatment.

Side effects

The side effects depend on the treated area and the sensitivity of each, which is not predictable. Some patients will have no side effects, others will. The lists below are not exhaustive and side effects may vary according to size and position of the tumor. These variations are explained by the radiation oncologist during the consultation and the occurrence of side effects can be properly assessed after completion of dosimetry. The occurrence of side effects can be properly assessed after completion of dosimetry.

Complications that can occur during irradiation of paraspinal tumors :

     – Fatigue

     – Nausea, vomiting, diarrhea,

     – If proximity to the spinal cord and nerves, a possible neurological toxicity can occur, that risk will be carefully evaluated and discussed with the patient based on the therapeutic challenge