{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:11:32Z","timestamp":1782738692733,"version":"3.54.5"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,7,28]]},"abstract":"\n BACKGROUND<\/jats:title>\n Chordomas of the upper cervical spine are rare. Recently, a relatively good long-term prognosis was reported for ion-beam radiotherapy. However, in a few cases, the tumor showed regrowth after radiotherapy. Resection is the treatment of choice in such cases, and spine surgery following ion-beam radiotherapy is associated with multiple complications. Here, the authors present a unique case of a C2 chordoma that showed regrowth after ion-beam radiotherapy.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 49-year-old man was diagnosed with a C2 chordoma and treated with ion-beam radiotherapy and posterior occipitocervical fusion. Five years later, the tumor showed regrowth, and complete macroscopic resection was successfully performed through mandibular splitting and the transoral approach under O-arm navigation assistance. However, wound healing of the posterior pharyngeal wall was unfavorable, and plastic surgeons created an osteocutaneous radial forearm free flap. Four years after surgery, no obvious local recurrence was observed.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights a unique scenario in which chordoma regrowth occurs after ion-beam radiotherapy. An anterior approach and complete tumor removal may result in a good outcome, but the surgical incision close to the irradiated field may fail to fuse. Therefore, spine surgeons and plastic surgeons should closely coordinate for proper wound closure in patients after ion-beam radiotherapy.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25241<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25241","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T06:32:32Z","timestamp":1753684352000},"source":"Crossref","is-referenced-by-count":1,"title":["Resection of C2 chordoma after failed ion-beam radiotherapy: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9934-9656","authenticated-orcid":true,"given":"Takahiro","family":"Onoki","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9644-054X","authenticated-orcid":true,"given":"Ko","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9705-0201","authenticated-orcid":true,"given":"Kohei","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken-ichiro","family":"Yahata","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Kusakabe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1634-3945","authenticated-orcid":true,"given":"Tomonori","family":"Kawaharada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruo","family":"Kanno","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimi","family":"Aizawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurooncol","first-page":"173","article-title":"Descriptive epidemiology of chordomas in the United States","volume":"148","author":"Das","year":"2020","unstructured":"Das PSoni PJones JDescriptive epidemiology of chordomas in the United States. J Neurooncol. 2020;148(1):173-178."},{"issue":"2","key":"bib2","series-title":"Lancet Oncol","first-page":"e69","article-title":"Chordoma: current concepts, management, and future directions","volume":"13","author":"Walcott","year":"2012","unstructured":"Walcott BPNahed BVMohyeldin ACoumans JVKahle KTFerreira MJ.Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13(2):e69-e76."},{"issue":"suppl 3","key":"bib3","series-title":"Eur Spine J","first-page":"440","article-title":"Intradural cervical chordoma with diffuse spinal leptomeningeal spread: case report and review of the literature","volume":"27","author":"Zhang","year":"2018","unstructured":"Zhang JGao CPLiu XJXu WJ.Intradural cervical chordoma with diffuse spinal leptomeningeal spread: case report and review of the literature. Eur Spine J. 2018;27(suppl 3):440-445."},{"issue":"5","key":"bib4","series-title":"J AAOS Glob Res Rev","first-page":"1","article-title":"An unusual chordoma of the odontoid process: a case report and literature of review","volume":"8","author":"Pongmanee","year":"2022","unstructured":"Pongmanee SSarasombach PRojdumrongrattana BLiawrungrueang W.An unusual chordoma of the odontoid process: a case report and literature of review. J AAOS Glob Res Rev. 2022;8(5):1-9."},{"issue":"1","key":"bib5","series-title":"J Med Case Rep","first-page":"229","article-title":"Midterm outcome after en bloc resection of C2 chordoma with transoral mandibular split and mesh cage reconstruction: a case report","volume":"17","author":"Korwutthikulrangsri","year":"2023","unstructured":"Korwutthikulrangsri EOngard SPisutbenya JRuangchainikom MSutipornpalangkul W.Midterm outcome after en bloc resection of C2 chordoma with transoral mandibular split and mesh cage reconstruction: a case report. J Med Case Rep. 2023;17(1):229."},{"issue":"1","key":"bib6","series-title":"Cancer Causes Control","first-page":"1","article-title":"Chordoma: incidence and survival patterns in the United States, 1973-1995","volume":"12","author":"McMaster","year":"2001","unstructured":"McMaster MLGoldstein AMBromley CMIshibe NParry DM.Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):1-11."},{"issue":"5","key":"bib7","series-title":"J Neurosurg","first-page":"1070","article-title":"Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease","volume":"97","author":"Carpentier","year":"2002","unstructured":"Carpentier APolivka MBlanquet ALot GGeorge B.Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease. J Neurosurg. 2002;97(5):1070-1077."},{"issue":"2","key":"bib8","series-title":"Head Neck Pathol","first-page":"261","article-title":"Chordoma of the head and neck: a review","volume":"12","author":"Wasserman","year":"2018","unstructured":"Wasserman JKGravel DPurgina B.Chordoma of the head and neck: a review. Head Neck Pathol. 2018;12(2):261-268."},{"issue":"10","key":"bib9","series-title":"Head Neck","first-page":"2162","article-title":"Long-term outcomes of high dose carbon-ion radiation therapy for unresectable upper cervical (C1-2) chordoma","volume":"44","author":"Aoki","year":"2022","unstructured":"Aoki SKoto MIkawa HLong-term outcomes of high dose carbon-ion radiation therapy for unresectable upper cervical (C1-2) chordoma. Head Neck. 2022;44(10):2162-2170."},{"issue":"11","key":"bib10","series-title":"Spine","first-page":"E505","article-title":"Complicated surgical resection of malignant tumors in the upper cervical spine after failed ion-beam radiation therapy","volume":"35","author":"Matsumoto","year":"2010","unstructured":"Matsumoto MWatanabe KIshii KComplicated surgical resection of malignant tumors in the upper cervical spine after failed ion-beam radiation therapy. Spine. 2010;35(11):E505-E509."},{"issue":"13","key":"bib11","series-title":"Spine","first-page":"1569","article-title":"Chordoma of the spine above the sacrum. Treatment and outcome in 21 cases","volume":"21","author":"Boriani","year":"1996","unstructured":"Boriani SChevalley FWeinstein JNChordoma of the spine above the sacrum. Treatment and outcome in 21 cases. Spine. 1996;21(13):1569-1577."},{"issue":"10","key":"bib12","series-title":"Bone Joint J","first-page":"1392","article-title":"Total spondylectomy following carbon ion radiotherapy to treat chordoma of the mobile spine","volume":"95-B","author":"Matsumoto","year":"2013","unstructured":"Matsumoto TImagama SIto ZTotal spondylectomy following carbon ion radiotherapy to treat chordoma of the mobile spine. Bone Joint J. 2013;95-B(10):1392-1395."},{"issue":"4","key":"bib13","series-title":"J Neurosurg Spine","first-page":"292","article-title":"Primary chordomas of the cervical spine: a consecutive series of 14 surgically managed cases","volume":"17","author":"Wang","year":"2012","unstructured":"Wang YXiao JWu ZPrimary chordomas of the cervical spine: a consecutive series of 14 surgically managed cases. J Neurosurg Spine. 2012;17(4):292-299."},{"issue":"5","key":"bib14","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Structure-sparing resection for the management of cervical chordomas: a retrospective institutional series","volume":"56","author":"Levy","year":"2024","unstructured":"Levy ASJamshidi AMCostello MCLevi AD.Structure-sparing resection for the management of cervical chordomas: a retrospective institutional series. Neurosurg Focus. 2024;56(5):E6."},{"issue":"1","key":"bib15","series-title":"Int J Radiat Oncol Biol Phys","first-page":"322","article-title":"Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases","volume":"95","author":"Imai","year":"2016","unstructured":"Imai RKamada TAraki NWorking Group for Bone and Soft Tissue Sarcomas.Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases. Int J Radiat Oncol Biol Phys. 2016;95(1):322-327."},{"issue":"1","key":"bib16","series-title":"Oncology","first-page":"30","article-title":"How to prevent local recurrence of sacral chordoma treated with carbon-ion radiotherapy: an analysis of the risk factors of local failure and an adequate disease margin","volume":"103","author":"Yanagawa","year":"2025","unstructured":"Yanagawa TOkamoto MOhno TChikuda H.How to prevent local recurrence of sacral chordoma treated with carbon-ion radiotherapy: an analysis of the risk factors of local failure and an adequate disease margin. Oncology. 2025;103(1):30-36."},{"issue":"1","key":"bib17","series-title":"Neurosurg Rev","first-page":"893","article-title":"Proton beam and carbon ion radiotherapy in skull base chordoma: a systematic review, metaanalysis and metaregression with trial sequential analysis","volume":"47","author":"Rodrigues","year":"2024","unstructured":"Rodrigues ACLFTos SMShaaban AMantziaris GTrifiletti DMSheehan J.Proton beam and carbon ion radiotherapy in skull base chordoma: a systematic review, metaanalysis and metaregression with trial sequential analysis. Neurosurg Rev. 2024;47(1):893."},{"issue":"11","key":"bib18","series-title":"Spine J","first-page":"928","article-title":"En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature","volume":"9","author":"Cloyd","year":"2009","unstructured":"Cloyd JMChou DDeviren VAmes CP.En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature. Spine J. 2009;9(11):928-935."},{"issue":"11","key":"bib19","series-title":"Int J Clin Oncol","first-page":"1490","article-title":"Clinical results of carbon-ion radiotherapy with separation surgery for primary spine\/paraspinal sarcomas","volume":"24","author":"Matsumoto","year":"2019","unstructured":"Matsumoto YMatsunobu AKawaguchi KClinical results of carbon-ion radiotherapy with separation surgery for primary spine\/paraspinal sarcomas. Int J Clin Oncol. 2019;24(11):1490-1497."},{"issue":"5","key":"bib20","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e365","article-title":"Extreme far-lateral approach for recurrent chordoma: 3-dimensional operative video","volume":"24","author":"Vigo","year":"2023","unstructured":"Vigo VAsmaro KPNunez MAExtreme far-lateral approach for recurrent chordoma: 3-dimensional operative video. Oper Neurosurg (Hagerstown). 2023;24(5):e365."},{"issue":"5","key":"bib21","series-title":"J Neurosurg","first-page":"1335","article-title":"Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection","volume":"135","author":"Fava","year":"2021","unstructured":"Fava ARusso PDTardivo VEndoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection. J Neurosurg. 2021;135(5):1335-1346."},{"issue":"5","key":"bib22","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1470","article-title":"Effect of carbon ion radiotherapy for sacral chordoma: results of phase I-II and phase II clinical trials","volume":"77","author":"Imai","year":"2010","unstructured":"Imai RKamada TTsuji HEffect of carbon ion radiotherapy for sacral chordoma: results of phase I-II and phase II clinical trials. Int J Radiat Oncol Biol Phys. 2010;77(5):1470-1476."},{"issue":"1","key":"bib1","series-title":"J Neurooncol","first-page":"173","article-title":"Descriptive epidemiology of chordomas in the United States","volume":"148","author":"Das","year":"2020","unstructured":"Das PSoni PJones JDescriptive epidemiology of chordomas in the United States. J Neurooncol. 2020;148(1):173-178."},{"issue":"2","key":"bib2","series-title":"Lancet Oncol","first-page":"e69","article-title":"Chordoma: current concepts, management, and future directions","volume":"13","author":"Walcott","year":"2012","unstructured":"Walcott BPNahed BVMohyeldin ACoumans JVKahle KTFerreira MJ.Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13(2):e69-e76."},{"issue":"suppl 3","key":"bib3","series-title":"Eur Spine J","first-page":"440","article-title":"Intradural cervical chordoma with diffuse spinal leptomeningeal spread: case report and review of the literature","volume":"27","author":"Zhang","year":"2018","unstructured":"Zhang JGao CPLiu XJXu WJ.Intradural cervical chordoma with diffuse spinal leptomeningeal spread: case report and review of the literature. Eur Spine J. 2018;27(suppl 3):440-445."},{"issue":"5","key":"bib4","series-title":"J AAOS Glob Res Rev","first-page":"1","article-title":"An unusual chordoma of the odontoid process: a case report and literature of review","volume":"8","author":"Pongmanee","year":"2022","unstructured":"Pongmanee SSarasombach PRojdumrongrattana BLiawrungrueang W.An unusual chordoma of the odontoid process: a case report and literature of review. J AAOS Glob Res Rev. 2022;8(5):1-9."},{"issue":"1","key":"bib5","series-title":"J Med Case Rep","first-page":"229","article-title":"Midterm outcome after en bloc resection of C2 chordoma with transoral mandibular split and mesh cage reconstruction: a case report","volume":"17","author":"Korwutthikulrangsri","year":"2023","unstructured":"Korwutthikulrangsri EOngard SPisutbenya JRuangchainikom MSutipornpalangkul W.Midterm outcome after en bloc resection of C2 chordoma with transoral mandibular split and mesh cage reconstruction: a case report. J Med Case Rep. 2023;17(1):229."},{"issue":"1","key":"bib6","series-title":"Cancer Causes Control","first-page":"1","article-title":"Chordoma: incidence and survival patterns in the United States, 1973-1995","volume":"12","author":"McMaster","year":"2001","unstructured":"McMaster MLGoldstein AMBromley CMIshibe NParry DM.Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):1-11."},{"issue":"5","key":"bib7","series-title":"J Neurosurg","first-page":"1070","article-title":"Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease","volume":"97","author":"Carpentier","year":"2002","unstructured":"Carpentier APolivka MBlanquet ALot GGeorge B.Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease. J Neurosurg. 2002;97(5):1070-1077."},{"issue":"2","key":"bib8","series-title":"Head Neck Pathol","first-page":"261","article-title":"Chordoma of the head and neck: a review","volume":"12","author":"Wasserman","year":"2018","unstructured":"Wasserman JKGravel DPurgina B.Chordoma of the head and neck: a review. Head Neck Pathol. 2018;12(2):261-268."},{"issue":"10","key":"bib9","series-title":"Head Neck","first-page":"2162","article-title":"Long-term outcomes of high dose carbon-ion radiation therapy for unresectable upper cervical (C1-2) chordoma","volume":"44","author":"Aoki","year":"2022","unstructured":"Aoki SKoto MIkawa HLong-term outcomes of high dose carbon-ion radiation therapy for unresectable upper cervical (C1-2) chordoma. Head Neck. 2022;44(10):2162-2170."},{"issue":"11","key":"bib10","series-title":"Spine","first-page":"E505","article-title":"Complicated surgical resection of malignant tumors in the upper cervical spine after failed ion-beam radiation therapy","volume":"35","author":"Matsumoto","year":"2010","unstructured":"Matsumoto MWatanabe KIshii KComplicated surgical resection of malignant tumors in the upper cervical spine after failed ion-beam radiation therapy. Spine. 2010;35(11):E505-E509."},{"issue":"13","key":"bib11","series-title":"Spine","first-page":"1569","article-title":"Chordoma of the spine above the sacrum. Treatment and outcome in 21 cases","volume":"21","author":"Boriani","year":"1996","unstructured":"Boriani SChevalley FWeinstein JNChordoma of the spine above the sacrum. Treatment and outcome in 21 cases. Spine. 1996;21(13):1569-1577."},{"issue":"10","key":"bib12","series-title":"Bone Joint J","first-page":"1392","article-title":"Total spondylectomy following carbon ion radiotherapy to treat chordoma of the mobile spine","volume":"95-B","author":"Matsumoto","year":"2013","unstructured":"Matsumoto TImagama SIto ZTotal spondylectomy following carbon ion radiotherapy to treat chordoma of the mobile spine. Bone Joint J. 2013;95-B(10):1392-1395."},{"issue":"4","key":"bib13","series-title":"J Neurosurg Spine","first-page":"292","article-title":"Primary chordomas of the cervical spine: a consecutive series of 14 surgically managed cases","volume":"17","author":"Wang","year":"2012","unstructured":"Wang YXiao JWu ZPrimary chordomas of the cervical spine: a consecutive series of 14 surgically managed cases. J Neurosurg Spine. 2012;17(4):292-299."},{"issue":"5","key":"bib14","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Structure-sparing resection for the management of cervical chordomas: a retrospective institutional series","volume":"56","author":"Levy","year":"2024","unstructured":"Levy ASJamshidi AMCostello MCLevi AD.Structure-sparing resection for the management of cervical chordomas: a retrospective institutional series. Neurosurg Focus. 2024;56(5):E6."},{"issue":"1","key":"bib15","series-title":"Int J Radiat Oncol Biol Phys","first-page":"322","article-title":"Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases","volume":"95","author":"Imai","year":"2016","unstructured":"Imai RKamada TAraki NWorking Group for Bone and Soft Tissue Sarcomas.Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases. Int J Radiat Oncol Biol Phys. 2016;95(1):322-327."},{"issue":"1","key":"bib16","series-title":"Oncology","first-page":"30","article-title":"How to prevent local recurrence of sacral chordoma treated with carbon-ion radiotherapy: an analysis of the risk factors of local failure and an adequate disease margin","volume":"103","author":"Yanagawa","year":"2025","unstructured":"Yanagawa TOkamoto MOhno TChikuda H.How to prevent local recurrence of sacral chordoma treated with carbon-ion radiotherapy: an analysis of the risk factors of local failure and an adequate disease margin. Oncology. 2025;103(1):30-36."},{"issue":"1","key":"bib17","series-title":"Neurosurg Rev","first-page":"893","article-title":"Proton beam and carbon ion radiotherapy in skull base chordoma: a systematic review, metaanalysis and metaregression with trial sequential analysis","volume":"47","author":"Rodrigues","year":"2024","unstructured":"Rodrigues ACLFTos SMShaaban AMantziaris GTrifiletti DMSheehan J.Proton beam and carbon ion radiotherapy in skull base chordoma: a systematic review, metaanalysis and metaregression with trial sequential analysis. Neurosurg Rev. 2024;47(1):893."},{"issue":"11","key":"bib18","series-title":"Spine J","first-page":"928","article-title":"En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature","volume":"9","author":"Cloyd","year":"2009","unstructured":"Cloyd JMChou DDeviren VAmes CP.En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature. Spine J. 2009;9(11):928-935."},{"issue":"11","key":"bib19","series-title":"Int J Clin Oncol","first-page":"1490","article-title":"Clinical results of carbon-ion radiotherapy with separation surgery for primary spine\/paraspinal sarcomas","volume":"24","author":"Matsumoto","year":"2019","unstructured":"Matsumoto YMatsunobu AKawaguchi KClinical results of carbon-ion radiotherapy with separation surgery for primary spine\/paraspinal sarcomas. Int J Clin Oncol. 2019;24(11):1490-1497."},{"issue":"5","key":"bib20","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e365","article-title":"Extreme far-lateral approach for recurrent chordoma: 3-dimensional operative video","volume":"24","author":"Vigo","year":"2023","unstructured":"Vigo VAsmaro KPNunez MAExtreme far-lateral approach for recurrent chordoma: 3-dimensional operative video. Oper Neurosurg (Hagerstown). 2023;24(5):e365."},{"issue":"5","key":"bib21","series-title":"J Neurosurg","first-page":"1335","article-title":"Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection","volume":"135","author":"Fava","year":"2021","unstructured":"Fava ARusso PDTardivo VEndoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection. J Neurosurg. 2021;135(5):1335-1346."},{"issue":"5","key":"bib22","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1470","article-title":"Effect of carbon ion radiotherapy for sacral chordoma: results of phase I-II and phase II clinical trials","volume":"77","author":"Imai","year":"2010","unstructured":"Imai RKamada TTsuji HEffect of carbon ion radiotherapy for sacral chordoma: results of phase I-II and phase II clinical trials. 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