J Neurol Surg B Skull Base 2016; 77(01): 038-046
DOI: 10.1055/s-0035-1554907
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Adjuvant Stereotactic Radiosurgery and Radiation Therapy for the Treatment of Intracranial Chordomas

Winward Choy
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
Sergei Terterov
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
Nolan Ung
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
Tania Kaprealian
2   Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States
,
Andy Trang
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
Antonio DeSalles
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
Lawrance K. Chung
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
Neil Martin
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
Michael Selch
2   Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States
,
Marvin Bergsneider
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
,
William Yong
3   Department of Pathology, University of California Los Angeles, Los Angeles, California, United States
,
Isaac Yang
1   Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
4   Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

10 February 2015

11 April 2015

Publication Date:
03 August 2015 (online)

Abstract

Objective Chordomas are locally aggressive, highly recurrent tumors requiring adjuvant radiotherapy following resection for successful management. We retrospectively reviewed patients treated for intracranial chordomas with adjuvant stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT).

Methods A total of 57 patients underwent 83 treatments at the UCLA Medical Center between February 1990 and August 2011. Mean follow-up was 57.8 months. Mean tumor diameter was 3.36 cm. Overall, 8 and 34 patients received adjuvant SRS and SRT, and the mean maximal dose of radiation therapy was 1783.3 cGy and 6339 cGy, respectively.

Results Overall rate of recurrence was 51.8%, and 1- and 5-year progression-free survival (PFS) was 88.2% and 35.2%, respectively. Gross total resection was achieved in 30.9% of patients. Adjuvant radiotherapy improved outcomes following subtotal resection (5-year PFS 62.5% versus 20.1%; p = 0.036). SRS and SRT produced comparable rates of tumor control (p = 0.28). Higher dose SRT (> 6,000 cGy) (p = 0.013) and younger age (< 45 years) (p = 0.03) was associated with improved rates of tumor control.

Conclusion Adjuvant radiotherapy is critical following subtotal resection of intracranial chordomas. Adjuvant SRT and SRS were safe and improved PFS following subtotal resection. Higher total doses of SRT and younger patient age were associated with improved rates of tumor control.

 
  • References

  • 1 Rich TA, Schiller A, Suit HD, Mankin HJ. Clinical and pathologic review of 48 cases of chordoma. Cancer 1985; 56 (1) 182-187
  • 2 Cummings BJ, Esses S, Harwood AR. The treatment of chordomas. Cancer Treat Rev 1982; 9 (4) 299-311
  • 3 Forsyth PA, Cascino TL, Shaw EG , et al. Intracranial chordomas: a clinicopathological and prognostic study of 51 cases. J Neurosurg 1993; 78 (5) 741-747
  • 4 Almefty K, Pravdenkova S, Colli BO, Al-Mefty O, Gokden M. Chordoma and chondrosarcoma: similar, but quite different, skull base tumors. Cancer 2007; 110 (11) 2457-2467
  • 5 Arnold H, Herrmann HD. Skull base chordoma with cavernous sinus involvement. Partial or radical tumour-removal?. Acta Neurochir (Wien) 1986; 83 (1–2) 31-37
  • 6 Colli BO, Al-Mefty O. Chordomas of the skull base: follow-up review and prognostic factors. Neurosurg Focus 2001; 10 (3) E1
  • 7 Colli B, Al-Mefty O. Chordomas of the craniocervical junction: follow-up review and prognostic factors. J Neurosurg 2001; 95 (6) 933-943
  • 8 Thodou E, Kontogeorgos G, Scheithauer BW , et al. Intrasellar chordomas mimicking pituitary adenoma. J Neurosurg 2000; 92 (6) 976-982
  • 9 Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Joint Surg Am 2005; 87 (10) 2211-2216
  • 10 York JE, Kaczaraj A, Abi-Said D , et al. Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery 1999; 44 (1) 74-79 ; discussion 79–80
  • 11 Yonemoto T, Tatezaki S, Takenouchi T, Ishii T, Satoh T, Moriya H. The surgical management of sacrococcygeal chordoma. Cancer 1999; 85 (4) 878-883
  • 12 Tzortzidis F, Elahi F, Wright D, Natarajan SK, Sekhar LN. Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chordomas. Neurosurgery 2006; 59 (2) 230-237 ; discussion 230–237
  • 13 Ozaki T, Hillmann A, Winkelmann W. Surgical treatment of sacrococcygeal chordoma. J Surg Oncol 1997; 64 (4) 274-279
  • 14 Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer 2000; 88 (9) 2122-2134
  • 15 Baratti D, Gronchi A, Pennacchioli E , et al. Chordoma: natural history and results in 28 patients treated at a single institution. Ann Surg Oncol 2003; 10 (3) 291-296
  • 16 Cheng EY, Ozerdemoglu RA, Transfeldt EE, Thompson Jr RC. Lumbosacral chordoma. Prognostic factors and treatment. Spine 1999; 24 (16) 1639-1645
  • 17 Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol 2012; 13 (2) e69-e76
  • 18 Bjornsson J, Wold LE, Ebersold MJ, Laws ER. Chordoma of the mobile spine. A clinicopathologic analysis of 40 patients. Cancer 1993; 71 (3) 735-740
  • 19 Osaka S, Kodoh O, Sugita H, Osaka E, Yoshida Y, Ryu J. Clinical significance of a wide excision policy for sacrococcygeal chordoma. J Cancer Res Clin Oncol 2006; 132 (4) 213-218
  • 20 Samii A, Gerganov VM, Herold C , et al. Chordomas of the skull base: surgical management and outcome. J Neurosurg 2007; 107 (2) 319-324
  • 21 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
  • 22 Hug EB, Slater JD. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. Neurosurg Clin N Am 2000; 11 (4) 627-638
  • 23 Wold LE, Laws Jr ER. Cranial chordomas in children and young adults. J Neurosurg 1983; 59 (6) 1043-1047
  • 24 Hauptman JS, Barkhoudarian G, Safaee M , et al. Challenges in linear accelerator radiotherapy for chordomas and chondrosarcomas of the skull base: focus on complications. Int J Radiat Oncol Biol Phys 2012; 83 (2) 542-551
  • 25 Erdem E, Angtuaco EC, Van Hemert R, Park JS, Al-Mefty O. Comprehensive review of intracranial chordoma. Radiographics 2003; 23 (4) 995-1009
  • 26 Noël G, Habrand JL, Jauffret E , et al. Radiation therapy for chordoma and chondrosarcoma of the skull base and the cervical spine. Prognostic factors and patterns of failure. Strahlenther Onkol 2003; 179 (4) 241-248
  • 27 Dahlin DC, MacCarty CS. Chordoma. Cancer 1952; 5 (6) 1170-1178
  • 28 Tamaki M, Aoyagi M, Kuroiwa T, Yamamoto M, Kishimoto S, Ohno K. Clinical course and autopsy findings of a patient with clival chordoma who underwent multiple surgeries and radiation during a 10-year period. Skull Base 2007; 17 (5) 331-340
  • 29 Raffel C, Wright DC, Gutin PH, Wilson CB. Cranial chordomas: clinical presentation and results of operative and radiation therapy in twenty-six patients. Neurosurgery 1985; 17 (5) 703-710
  • 30 Munzenrider JE, Liebsch NJ. Proton therapy for tumors of the skull base. Strahlenther Onkol 1999; 175 (Suppl. 02) 57-63
  • 31 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
  • 32 Amichetti M, Cianchetti M, Amelio D, Enrici RM, Minniti G. Proton therapy in chordoma of the base of the skull: a systematic review. Neurosurg Rev 2009; 32 (4) 403-416
  • 33 Noël G, Habrand JL, Mammar H , et al. Combination of photon and proton radiation therapy for chordomas and chondrosarcomas of the skull base: the Centre de Protonthérapie D'Orsay experience. Int J Radiat Oncol Biol Phys 2001; 51 (2) 392-398
  • 34 Eid AS, Chang UK, Lee SY, Jeon DG. The treatment outcome depending on the extent of resection in skull base and spinal chordomas. Acta Neurochir (Wien) 2011; 153 (3) 509-516
  • 35 Hasegawa T, Ishii D, Kida Y, Yoshimoto M, Koike J, Iizuka H. Gamma Knife surgery for skull base chordomas and chondrosarcomas. J Neurosurg 2007; 107 (4) 752-757
  • 36 Ito E, Saito K, Okada T, Nagatani T, Nagasaka T. 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
  • 37 Krishnan S, Foote RL, Brown PD, Pollock BE, Link MJ, Garces YI. Radiosurgery for cranial base chordomas and chondrosarcomas. Neurosurgery 2005; 56 (4) 777-784; discussion 777–784
  • 38 Martin JJ, Niranjan A, Kondziolka D, Flickinger JC, Lozanne KA, Lunsford LD. Radiosurgery for chordomas and chondrosarcomas of the skull base. J Neurosurg 2007; 107 (4) 758-764
  • 39 Jensen AD, Nikoghosyan A, Ellerbrock M, Ecker S, Debus J, Münter MW. Re-irradiation with scanned charged particle beams in recurrent tumours of the head and neck: acute toxicity and feasibility. Radiother Oncol 2011; 101 (3) 383-387
  • 40 Heylen S, Michielsen J, Mahieu G, Somville J. Recurrent chordoma of the L2 vertebra: a case report. Acta Orthop Belg 2010; 76 (3) 416-419
  • 41 Jian BJ, Bloch OG, Yang I, Han SJ, Aranda D, Parsa AT. A comprehensive analysis of intracranial chordoma and survival: a systematic review. Br J Neurosurg 2011; 25 (4) 446-453
  • 42 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
  • 43 Chang SD, Martin DP, Lee E, Adler Jr JR. Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for residual or recurrent cranial base and cervical chordomas. Neurosurg Focus 2001; 10 (3) E5
  • 44 Dassoulas K, Schlesinger D, Yen CP, Sheehan J. The role of Gamma Knife surgery in the treatment of skull base chordomas. J Neurooncol 2009; 94 (2) 243-248
  • 45 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
  • 46 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
  • 47 Tai PT, Craighead P, Liem SK, Jo BH, Stitt L, Tonita J. Management issues in chordoma: a case series. Clin Oncol (R Coll Radiol) 2000; 12 (2) 80-86
  • 48 Crockard HA, Steel T, Plowman N , et al. A multidisciplinary team approach to skull base chordomas. J Neurosurg 2001; 95 (2) 175-183
  • 49 Catton C, O'Sullivan B, Bell R , et al. Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 1996; 41 (1) 67-72
  • 50 Pearlman AW, Friedman M. Radical radiation therapy of chordoma. Am J Roentgenol Radium Ther Nucl Med 1970; 108 (2) 332-341
  • 51 Schulz-Ertner D, Nikoghosyan A, Thilmann C , et al. Results of carbon ion radiotherapy in 152 patients. Int J Radiat Oncol Biol Phys 2004; 58 (2) 631-640
  • 52 Weber DC, Rutz HP, Pedroni ES , et al. Results of spot-scanning proton radiation therapy for chordoma and chondrosarcoma of the skull base: the Paul Scherrer Institut experience. Int J Radiat Oncol Biol Phys 2005; 63 (2) 401-409