open access

Vol 24, No 1 (2019)
Original research articles
Published online: 2019-01-01
Submitted: 2018-05-07
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Adjuvant gamma knife surgery and image-guided, intensity-modulated radiation therapy for the treatment of sacral chordomas

Shun Lu, Xinhao Peng, Bingwen Zou, Cheng Zhou, Mei Feng, Jinyi Lang
DOI: 10.1016/j.rpor.2018.10.007
·
Rep Pract Oncol Radiother 2019;24(1):74-79.

open access

Vol 24, No 1 (2019)
Original research articles
Published online: 2019-01-01
Submitted: 2018-05-07

Abstract

Aim

The aim of this study was to confirm whether patients with sacral chordoma benefit from adjuvant radiotherapy and to determine the optimal photon radiotherapy module for comprehensive treatment.

Background

Chordoma is a rare slow-growing neoplasm arisen from cellular remnants of the notochord. About 50% occur in the sacrococcygeal region. Surgical resection and adjuvant radiation therapy are recommended treatment due to the improving local control rate.

Materials and methods

118 patients treated by surgery and adjuvant radiotherapy from August 2003 to May 2015 were retrospectively analyzed. All patients received surgical resection after diagnosis. Among these patients, 44 were treated by exclusive surgery, and 48 were treated with adjuvant image-guided, intensity-modulated radiation therapy (IG-IMRT). In addition, 26 patients were treated with gamma knife surgery (GKS) after surgical resection. The median follow-up was 54 months for all patients. Kaplan–Meier analysis was used to calculate recurrence-free survival (RFS) overall survival (OS).

Results

Patients treated with adjuvant radiotherapy had better RFS (p=0.014) than those treated exclusively by surgery. The patients in the IG-IMRT group exhibited better recurrence-free survival (p=0.01) than the GKS group. Moreover, in the IG-IMRT group, patients treated by higher dose were associated with better RFS (p=0.04). No significant difference in OS was found. No grade 3 late toxicity was found.

Conclusions

We confirmed that adjuvant radiotherapy improved RFS but not OS in sacral chordoma patients after surgery. Furthermore, favorable RFS and low adverse event rates were observed following IG-IMRT. Our results suggest that high dose IG-IMRT is an appropriate module of adjuvant radiotherapy for sacral chordoma patients.

Abstract

Aim

The aim of this study was to confirm whether patients with sacral chordoma benefit from adjuvant radiotherapy and to determine the optimal photon radiotherapy module for comprehensive treatment.

Background

Chordoma is a rare slow-growing neoplasm arisen from cellular remnants of the notochord. About 50% occur in the sacrococcygeal region. Surgical resection and adjuvant radiation therapy are recommended treatment due to the improving local control rate.

Materials and methods

118 patients treated by surgery and adjuvant radiotherapy from August 2003 to May 2015 were retrospectively analyzed. All patients received surgical resection after diagnosis. Among these patients, 44 were treated by exclusive surgery, and 48 were treated with adjuvant image-guided, intensity-modulated radiation therapy (IG-IMRT). In addition, 26 patients were treated with gamma knife surgery (GKS) after surgical resection. The median follow-up was 54 months for all patients. Kaplan–Meier analysis was used to calculate recurrence-free survival (RFS) overall survival (OS).

Results

Patients treated with adjuvant radiotherapy had better RFS (p=0.014) than those treated exclusively by surgery. The patients in the IG-IMRT group exhibited better recurrence-free survival (p=0.01) than the GKS group. Moreover, in the IG-IMRT group, patients treated by higher dose were associated with better RFS (p=0.04). No significant difference in OS was found. No grade 3 late toxicity was found.

Conclusions

We confirmed that adjuvant radiotherapy improved RFS but not OS in sacral chordoma patients after surgery. Furthermore, favorable RFS and low adverse event rates were observed following IG-IMRT. Our results suggest that high dose IG-IMRT is an appropriate module of adjuvant radiotherapy for sacral chordoma patients.

Get Citation

Keywords

Sacral chordoma; Adjuvant radiotherapy; Image-guided intensity modulated radiotherapy; Gamma knife surgery; Survival

About this article
Title

Adjuvant gamma knife surgery and image-guided, intensity-modulated radiation therapy for the treatment of sacral chordomas

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 24, No 1 (2019)

Pages

74-79

Published online

2019-01-01

DOI

10.1016/j.rpor.2018.10.007

Bibliographic record

Rep Pract Oncol Radiother 2019;24(1):74-79.

Keywords

Sacral chordoma
Adjuvant radiotherapy
Image-guided intensity modulated radiotherapy
Gamma knife surgery
Survival

Authors

Shun Lu
Xinhao Peng
Bingwen Zou
Cheng Zhou
Mei Feng
Jinyi Lang

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