@misc{oai:repo.qst.go.jp:00063644,
 author = {Hasegawa, Azusa and Mizoe, Junetsu and Jingu, Keiichi and Bessho, Hiroki and Kamada, Tadashi and Tsujii, Hirohiko and 長谷川 安都佐 and 溝江 純悦 and 神宮 啓一 and 別所 央城 and 鎌田 正 and 辻井 博彦},
 month = {Oct},
 note = {Purpose: To estimate the toxicity and efficacy of carbon ion radiotherapy for head-and-neck tumors invading the skull base.
Materials and Methods: Between April 1997 and March 2007, a total of 278 patients with head-and-neck tumors were treated with carbon ion radiotherapy with a phase II clinical trial. All of these patients had neither regional lymph node nor distant metastasis before carbon ion radiotherapy. The prescribed tumor doses were 57.6 or 64.0 GyE in 16 fractions over four weeks. Of the 278 patients, 93 patients with skull base invasion were analyzed. 
Results: The patients consisted of 51 males and 42 females aged from 23 to 78 years with an average age of 55.4 years. Histologically, tumors were classified as follows: 43 were adenoid cystic carcinoma, 23 were malignant mucosal melanoma, 22 were adenocarcinoma, and 5 other histological types. The CTV ranged from 53.6 to 670.1 ml, with an average of 208.0 ml. Median follow-up time was 32.5 months (range, 2.6-143 months). Although acute grade 3 skin and mucosal reactions appeared in 4 patients (4 %) and 9 patients (10 %), the late skin and mucosal reactions were grade 1 or less. Only one patient developed late grade 2 mucosal reaction.  In regard to brain toxicity, 12 patients (13 %) developed late grade 2 brain reactions, which necessitated steroid administration. All these patients can now manage without any medication because these reactions improved within a short time. At the time of analysis, there was no evidence of any serious late reactions. 
     The 5-year local control and overall survival rates were 75 % and 46 %, respectively. There were no significant differences in local control rates between histological types. In total 56 patients died, 30 were distant metastasis, 7 were in field recurrence, 7 were marginal recurrences, 2 were meningeal disseminations, and 10 were due to other causes that are not associated with tumors. Fourteen of 23 mucosal malignant melanomas died due to distant metastasis (46 %). The 3 and 5-year overall survival rates for mucosal malignant melanoma were 32 % and 7 %, respectively. Patients were divided into two groups according to intracranial involvement; Group A was made up of 44 patients whose tumors abutted the cranial fossa, Group B consisted of 49 patients whose tumors displaced or invaded the frontal or temporal lobe. The 5-year local control rates were 74 % for Group A and 75 % for Group B. The 5-year overall survival rates were 43 % for Group A and 39 % for Group B.  There was no significant difference in outcome between the two groups.
Conclusions: This set of patients with non-squamous cell locally advanced tumors can be considered poor candidates for photon radiotherapy, on the other hand carbon ion radiotherapy showed excellent therapeutic effectiveness., PTCOG 48},
 title = {Carbon ion radiotherapy for skull base and paracervical chordomas},
 year = {2009}
}