Long-term Efficacy and Safety of Carbon-ion Radiotherapy for Thoracic Chordoma: A Case Report

We report a case of inoperable thoracic chordoma successfully treated with carbon-ion radiotherapy (C-ion RT).

A 65-year-old male patient underwent computed tomography for evaluation of a benign thyroid nodule and was incidentally diagnosed with thoracic chordoma without metastasis. A physical examination revealed increased tendon reflexes in the lower extremities. Magnetic resonance imaging revealed a tumour measuring 52 mm in maximum diameter, located from the seventh cervical to the third thoracic vertebrae, compressing a wide area of the spinal cord. The patient was unsuitable for surgery due to the high risk of severe postoperative neurological dysfunction. The patient received C-ion RT at a total dose of 64.0 Gy (relative biological effectiveness), delivered in 16 fractions. The patient completed C-ion RT as scheduled; however, the patient experienced transient Lhermitte's sign, classified as grade 1 acute neuropathy, during treatment. The patient is alive 96 months after C-ion RT initiation with no evidence of local recurrence or distant metastasis, remains ambulatory, and has developed no grade 2 or higher toxicities other than the grade 1 neuropathy that was present prior to the initiation of C-ion RT.

We observed a favourable local response with manageable toxicity in a patient with thoracic chordoma treated with C-ion RT. Although this is a single-case report, our findings suggest that C-ion RT could be considered a viable treatment option for thoracic chordomas.