Long-term clinical safety of high-dose proton radiotherapy delivered with pencil beam scanning technique for extracranial chordomas and chondrosarcomas in adult patients: Clinical evidence of spinal cord tolerance

Limited clinical data to define the radiotherapy tolerance of the spinal cord are available to clinicians. To add further clarity, we retrospectively evaluated our patients treated with proton therapy only for spinal chordomas and chondrosarcomas, who received a spinal cord dose in excess of 45 Gy(RBE) with special regard to neurotoxicity. Radiation doses reaching 64 Gy(RBE) to the surface of the spinal cord were associated with limited toxicity, defining this cut-off dose level as a safe threshold for appropriate clinical use.

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