【The story of coordinator】 Chordoma, which is difficult to treat, is treated with heavy ion therapy.The treatment is minimally invasive procedure on a walk-in basis, so accompanying families can go sightseeing.

From when a patient requested for heavy ion therapy to his arrival to Japan

A doctor told the patient to contact EAJ.

A patient living in Australia made contact doctors at the National Institute of Radiological Sciences Hospital (now QST Hospital) through his local doctor’s connections. Then, the patient contacted EAJ after being told by the doctor at QST Hospital that it was possible to treat his sacral chordoma with heavy ion radiation and that he should contact EAJ as a point of communication. The patient wished to receive treatment as soon as possible, if possible, but there was equipment maintenance until just around the time he planned to come to Japan, so we began by arranging a schedule. We were fortunate to be able to make an appointment at the fastest possible time after maintenance. This patient was scheduled to be treated twice, not simultaneously but consecutively, in each of the two sites on the left and right sides of the back of the sacrum, according to preliminary image confirmation, so we made necessary arrangements so that the patient can return home by flight two months after his arrival in Japan with a changeable ticket.

Chordoma difficult to treat with surgery or ordinary radiation

Chordomas are tumors that form in the lower part of the skull and sacral region, where many nerves and blood vessels pass through this area to the face and neck, and are considered very difficult to treat. In surgery, it is extremely difficult to remove the tumor without damaging the surrounding normal nerves, etc., because the tumor is deep, and even if it can be removed, there is a risk of early recurrence because the tumor cells have invaded the bone. It is also difficult to apply high doses of radiation without complications using normal radiation. Heavy ion beams can release maximum energy at specific depths, even if the tumor is deep, and the delivery of radiation results in significant damage to the tumor’s DNA, which are very difficult for the tumor to repair, so recurrence is relatively low. For this reason, heavy ion radiation can be a very effective option for the treatment of chordoma.

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Living support for long-term stays

Since the patient will be staying in Japan for almost two months to receive medical treatment, we made various arrangements for a long stay in Japan as well as a medical stay visa. First, we secured a serviced apartment near a medical facility with a kitchen so that the patient can live with their families in daily activities such as cooking and doing laundry.

We also booked a large-sized hire car to take them from the airport to their apartments, as they would have a lot of luggage, and lent them a prepaid cell phone so that they could contact EAJ at any time. After the visit to Japan, the interpreter showed the patients where they could shop and where they could withdraw cash from ATM after the medical examination. We were also informed of from them that their children would be visiting Japan during the course of his treatment, and at that time we gave them information about sightseeing in Tokyo and the monorail that goes to the zoo in Chiba.

Arrived in Japan and started treatment.

Preparing for Heavy Ion Therapy

The patient arrived in Japan as scheduled for his initial consultation and examination date. First, an examination was performed to confirm that the patient is ready for the final treatment. Then we obtained Informed Consent about the treatment. Though an explanation paper was prepared, our interpreter provided a detailed explanation. Next, a mold was taken to make a fixture to stabilize the treatment table and body in place so that the body does not move during irradiation. It takes about one week for the fixture and irradiation plan to be ready. The first irradiation began approximately 10 days after his arrival in Japan.

Start of irradiation

This time, the patient was to be irradiated four times a week for three weeks for a total of 12 sessions on a walk-in basis, after which a treatment plan for the other side of the tumor would be decided. According to the plan, the irradiation was performed in four directions, one direction per irradiation, and was circularized so that the irradiated area was to be the same circular shape as the tumor. An interpreter accompanied the patient at each irradiation and weekly consultations. The patient had received conventional radiotherapy about 10 years earlier. It may not be accurate because there are no such cases here, but the 5-year cancer control rate (how many years without recurrence) for sacral chordoma irradiated at the QST hospital was 89% at that time. The treatment went so well that the irradiation of the other side was scheduled to take place as well. We obtained Informed Consent once again and manufacturing a mold for the purpose to fix the body was repeated. On one occasion, the patient complained of dental problems during his stay, and was seen by a dentist at the medical hospital who was scheduled to visit there just the next week. Since the treatment was an outpatient visit, he was able to have time to relax and go out with his family on the bullet train on days when he did not have irradiation.

After returning home

The patient returned to work three times a week after returning home. One month after the last irradiation, MRI images were sent from the country of his residence for follow-up, which were reviewed by the treating doctor. After this case, we continued to receive a number of contacts from Australia from chordoma patients who wanted to receive heavy ion radiation, and many of them received the treatments.