Vol 26, No 5 (2021)
Research paper
Published online: 2021-08-16
Intracranial chordoma: radiosurgery, hypofractionated stereotactic radiotherapy and treatment outcomes
Rep Pract Oncol Radiother 2021;26(5):764-772.
Abstract
Background: The aim of the study was to assess the results of stereotactic radiosurgery and hypofractionated stereotactic radiotherapy (SRS/SRT) for skull base chordomas.
Materials and methods: Twenty-three patients aged 12–75 were treated with SRS/SRT due to skull base chordoma. In 19 patients SRS/SRT was a part of the primary therapy, while in 4, a part of the treatment of recurrence. In 4 patients SRS/SRT was used as a boost after conventional radiotherapy and in 19 cases it was the only irradiation method applied. Patients were irradiated to total dose of 6–35 Gy and median total equivalent dose of 52 Gy.
Results: During median follow-up of 39 months, 4 patients died. One-, two- and five-year OS was 95%, 89% and 69%, respectively. In nine patients, progression of the disease was diagnosed during study period. One-, two- and five-year progression free survival (PFS) from the end of radiotherapy was 81%, 59% and 43%, respectively. Radiotherapy was well tolerated and only two patients in our group experienced moderate treatment-related toxicity.
Conclusion: SRS/SRT alone or in combination with surgery is a safe and effective method of irradiation of patients with skull base chordomas. High EQD2 is necessary to achieve satisfactory treatment results.
Keywords: chordomarare tumorsradiotherapystereotactic radiotherapyskull base tumors
References
- Zorlu F, Gultekin M, Cengiz M, et al. Fractionated stereotactic radiosurgery treatment results for skull base chordomas. Technol Cancer Res Treat. 2014; 13(1): 11–19.
- Jones PS, Aghi MK, Muzikansky A, et al. Outcomes and patterns of care in adult skull base chordomas from the Surveillance, Epidemiology, and End Results (SEER) database. J Clin Neurosci. 2014; 21(9): 1490–1496.
- Makhdoomi R, Ramzan A, Khursheed N, et al. Clinicopathological characteristics of chordoma: an institutional experience and a review of the literature. Turk Neurosurg. 2013; 23(6): 700–706.
- Chibbaro S, Cornelius JF, Froelich S, et al. Endoscopic endonasal approach in the management of skull base chordomas--clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev. 2014; 37(2): 217–24; discussion 224.
- Sen C, Triana AI, Berglind N, et al. Clival chordomas: clinical management, results, and complications in 71 patients. J Neurosurg. 2010; 113(5): 1059–1071.
- Tan NCW, Naidoo Y, Oue S, et al. Endoscopic surgery of skull base chordomas. J Neurol Surg B Skull Base. 2012; 73(6): 379–386.
- Rachinger W, Eigenbrod S, Dützmann S, et al. Male sex as a risk factor for the clinical course of skull base chordomas. J Neurosurg. 2014; 120(6): 1313–1320.
- Amichetti M, Amelio D, Minniti G, et al. Proton therapy in chordoma of the base of the skull: a systematic review. Neurosurg Rev. 2009; 32(4): 403–416.
- Fuji H, Nakasu Y, Ishida Y, et al. Feasibility of proton beam therapy for chordoma and chondrosarcoma of the skull base. Skull Base. 2011; 21(3): 201–206.
- Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5): 1341–1346.
- Almefty K, Pravdenkova S, Colli BO, et al. Chordoma and chondrosarcoma: similar, but quite different, skull base tumors. Cancer. 2007; 110(11): 2457–2467.
- Debus J, Schulz-Ertner D, Schad L, et al. Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys. 2000; 47(3): 591–596.
- Di Maio S, Kong E, Yip S, et al. Converging paths to progress for skull base chordoma: Review of current therapy and future molecular targets. Surg Neurol Int. 2013; 4: 72.
- Foweraker KL, Burton KE, Maynard SE, et al. High-dose radiotherapy in the management of chordoma and chondrosarcoma of the skull base and cervical spine: Part 1--Clinical outcomes. Clin Oncol (R Coll Radiol). 2007; 19(7): 509–516.
- Hug EB, Loredo LN, Slater JD, et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg. 1999; 91(3): 432–439.
- Igaki H, Tokuuye K, Okumura T, et al. Clinical results of proton beam therapy for skull base chordoma. Int J Radiat Oncol Biol Phys. 2004; 60(4): 1120–1126.
- Ito E, Saito K, Okada T, et al. Long-term control of clival chordoma with initial aggressive surgical resection and gamma knife radiosurgery for recurrence. Acta Neurochir (Wien). 2010; 152(1): 57–67; discussion 67.
- Noël G, Feuvret L, Calugaru V, et al. Chordomas of the base of the skull and upper cervical spine. One hundred patients irradiated by a 3D conformal technique combining photon and proton beams. Acta Oncol. 2005; 44(7): 700–708.
- Pallini R, Maira G, Pierconti F, et al. Chordoma of the skull base: predictors of tumor recurrence. J Neurosurg. 2003; 98(4): 812–822.
- Pamir MN, Ozduman K. Tumor-biology and current treatment of skull-base chordomas. Adv Tech Stand Neurosurg. 2008; 33: 35–129.
- Samii A, Gerganov VM, Herold C, et al. Chordomas of the skull base: surgical management and outcome. J Neurosurg. 2007; 107(2): 319–324.
- Schulz-Ertner D, Karger CP, Feuerhake A, et al. Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas. Int J Radiat Oncol Biol Phys. 2007; 68(2): 449–457.
- Stüer C, Schramm J, Schaller C. Skull base chordomas: management and results. Neurol Med Chir (Tokyo). 2006; 46(3): 118–24; discussion 124.
- Takahashi S, Kawase T, Yoshida K, et al. Skull base chordomas: efficacy of surgery followed by carbon ion radiotherapy. Acta Neurochir (Wien). 2009; 151(7): 759–769.
- Tamaki N, Nagashima T, Ehara K, et al. Surgical approaches and strategies for skull base chordomas. Neurosurg Focus. 2001; 10(3): E9.
- Tzortzidis F, Elahi F, Wright D, et al. Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chordomas. Neurosurgery. 2006; 59(2): 230–7; discussion 230.
- Yoneoka Y, Tsumanuma I, Fukuda M, et al. Cranial base chordoma--long term outcome and review of the literature. Acta Neurochir (Wien). 2008; 150(8): 773–8; discussion 778.
- Bugoci DM, Girvigian MR, Chen JCT, et al. Photon-based fractionated stereotactic radiotherapy for postoperative treatment of skull base chordomas. Am J Clin Oncol. 2013; 36(4): 404–410.
- Chang SD, Martin DP, Lee E, et al. Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for residual or recurrent cranial base and cervical chordomas. Neurosurg Focus. 2001; 10(3): E5.
- Dassoulas K, Schlesinger D, Yen CPo, et al. The role of Gamma Knife surgery in the treatment of skull base chordomas. J Neurooncol. 2009; 94(2): 243–248.
- Hasegawa T, Ishii D, Kida Y, et al. Gamma Knife surgery for skull base chordomas and chondrosarcomas. J Neurosurg. 2007; 107(4): 752–757.
- Henderson FC, McCool K, Seigle J, et al. Treatment of chordomas with CyberKnife: georgetown university experience and treatment recommendations. Neurosurgery. 2009; 64(2 Suppl): A44–A53.
- Jiang B, Veeravagu A, Lee M, et al. Management of intracranial and extracranial chordomas with CyberKnife stereotactic radiosurgery. J Clin Neurosci. 2012; 19(8): 1101–1106.
- Kano H, Iqbal FO, Sheehan J, et al. Stereotactic radiosurgery for chordoma: a report from the North American Gamma Knife Consortium. Neurosurgery. 2011; 68(2): 379–389.
- Kim JiH, Jung HHo, Chang JH, et al. Gamma Knife surgery for intracranial chordoma and chondrosarcoma: radiosurgical perspectives and treatment outcomes. J Neurosurg. 2014; 121 Suppl: 188–197.
- Koga T, Shin M, Saito N. Treatment with high marginal dose is mandatory to achieve long-term control of skull base chordomas and chondrosarcomas by means of stereotactic radiosurgery. J Neurooncol. 2010; 98(2): 233–238.
- Krishnan S, Foote RL, Brown PD, et al. Radiosurgery for cranial base chordomas and chondrosarcomas. Neurosurgery. 2005; 56(4): 777–84; discussion 777.
- Liu AL, Wang ZC, Sun SB, et al. Gamma knife radiosurgery for residual skull base chordomas. Neurol Res. 2008; 30(6): 557–561.
- Martin JJ, Niranjan A, Kondziolka D, et al. Radiosurgery for chordomas and chondrosarcomas of the skull base. J Neurosurg. 2007; 107(4): 758–764.
- Muthukumar N, Kondziolka D, Lunsford LD, et al. Stereotactic radiosurgery for chordoma and chondrosarcoma: further experiences. Int J Radiat Oncol Biol Phys. 1998; 41(2): 387–392.