Defining optimal strategies for diagnosis, treatment and treatment evaluation of chordomas and chondrosarcomas of the axial skeleton

Principal Investigator: dr. A. Krol (LUMC)

PhD students: V. Miladinovic (LUMC)

Funding: HollandPTC-Varian 2018


Proton therapy for chordomas (CH) and chondrosarcomas (CS) of the axial skeleton is reimbursed as standard of care in the Netherlands. MR imaging is key in guiding proton therapy and evaluating response to this treatment. However, knowledge about the optimal set of MR parameters to locally stage the tumour and monitor the effect of (proton)therapy in early and late stages of treatment is limited. To a larger extent this holds true for the application of FDG—PET techniques in the diagnosis, guiding and response evaluation of CH and CS after proton therapy. The research proposed will deliver a set of multimodality morphologic and functional imaging criteria that will help guide (adaptive) proton therapy and evaluate its effect for patients with CH or CS referred for proton therapy to HollandPTC.


The aims of the project are:

  1. To accurately differentiate between the two main tumour types CS and chordoma and its low and aggressive sub-types (CS grade 2, and dedifferentiated chordoma) using imaging parameters.
  2. To identify viable tumour nodules in untreated and previously treated CS and chordomas to enable therapeutic targeting (proton beam therapy).
  3. To establish a reliable and user-friendly workflow for image fusion of diagnostic imaging datasets with the HollandPTC planning-CT to accurately plan and deliver focused proton beam therapy.
  4. To determine early and late response to radiotherapy allowing respectively adaptive proton therapy planning and response to treatment evaluation.
  5. To identify parameters that predict prognosis.