Stereotactic radiosurgery for chordoma: a report from the North American Gamma Knife Consortium.
ABSTRACT Although considered slow-growing, low-grade malignancies, chordomas are locally aggressive and destructive tumors with high recurrence rates.
To assess patient survival, tumor control, complications, and selected variables that predict outcome in patients who underwent Gamma Knife stereotactic radiosurgery (SRS) as primary, adjuvant, or salvage management for chordomas of the skull base.
Six participating centers of the North American Gamma Knife Consortium identified 71 patients who underwent SRS for chordoma. The median patient age was 45 years (range, 7-80 years). The median SRS target volume was 7.1 cm³ (range, 0.9-109 cm³), and median margin dose was 15.0 Gy (range, 9-25 Gy).
At a median follow-up of 5 years (range, 0.6-14 years) after SRS, 23 patients died of tumor progression. The 5-year actuarial overall survival after SRS was 80% for the entire group, 93% for the no prior fractionated radiation therapy (RT) group (n = 50), and 43% for the prior RT group (n = 21). Younger age, longer interval between initial diagnosis and SRS, no prior RT, < 2 cranial nerve deficits, and smaller total tumor volume were significantly associated with longer patient survival. The 5-year treated tumor control rate after SRS was 66% for the entire group, 69% for the no prior RT group, and 62% for the prior RT group. Older age, recurrent group, prior RT, and larger tumor volume were significantly associated with worse tumor control.
Stereotactic radiosurgery is a potent treatment option for small sized chordomas, especially in younger patients and as part of a multipronged attack that includes surgical resection when possible.
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ABSTRACT: To report the results in patients reirradiated with proton therapy for recurrent or progressive chordoma, with or without salvage surgery. A retrospective review of 16 consecutive patients treated from 2005 to 2012 was performed. All patients had received at least 1 prior course of radiation therapy to the same area, and all but 1 patient had at least 1 surgical resection for disease before receiving reirradiation. At the time of recurrence or progression, half of the patients underwent additional salvage surgery before receiving reirradiation. The median prior dose of radiation was 75.2 Gy (range, 40-79.2 Gy). Six patients had received prior proton therapy, and the remainder had received photon radiation. The median gross tumor volume at the time of reirradiation was 71 cm(3) (range, 0-701 cm(3)). Reirradiation occurred at a median interval of 37 months after prior radiation (range, 12-129 months), and the median dose of reirradiation was 75.6 Gy (relative biological effectiveness [RBE]) (range. 71.2-79.2 Gy [RBE]), given in standard daily fractionation (n=14) or hyperfractionation (n=2). The median follow-up time was 23 months (range, 6-63 months); it was 26 months in patients alive at the last follow-up visit (range, 12-63 months). The 2-year estimate for local control was 85%, overall survival 80%, chordoma-specific survival 88%, and development of distant metastases 20%. Four patients have had local progression: 3 in-field and 1 marginal. Late toxicity included grade 3 bitemporal lobe radionecrosis in 1 patient that improved with hyperbaric oxygen, a grade 4 cerebrospinal fluid leak with meningitis in 1 patient, and a grade 4 ischemic brainstem stroke (out of radiation field) in 1 patient, with subsequent neurologic recovery. Full-dose proton reirradiation provided encouraging initial disease control and overall survival for patients with recurrent or progressive chordoma, although additional toxicities may develop with longer follow-up times.International journal of radiation oncology, biology, physics 12/2013; 87(5):1107-1114. · 4.59 Impact Factor
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ABSTRACT: Objective: To determine trends in survival patterns for cranial chordoma in the United States. Study Design: A cross-sectional analysis of a national healthcare database. Methods: From the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, all cases of microscopically confirmed cranial chordoma, between 1973 and 2009, were examined. Age-adjusted incidence and survival rates were calculated and stratified by treatment. Additionally, in order to assess trends over time, comparisons in survival were conducted for three calendar year cohorts: 1975-1984, 1985-1994, and 1995-2004. Results: A total of 594 cases of microscopically confirmed chordoma involving cranial sites were identified, which accounted for 42% of all chordomas. Age-adjusted incidence rate (IR) of all chordomas was 0.089 per 100,000. Overall median survival time with surgery plus radiation was 9.2 years. Age and treatment modality were found to influence patient survival. Specifically, age >50 years was associated with a significant increase in mortality rate (P <.05). Five-year survival for the 1975-1984, 1985-1994, and 1995-2004 cohort was 48.5%, 73.0%, and 80.7%, respectively, with improved survival in the more recent cohorts (P<0.01). Conclusion: This study provides new data regarding survival patterns of cranial chordoma in the United States, with a trend toward improvement in survival in recent decades.The Laryngoscope 10/2013; · 2.03 Impact Factor
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ABSTRACT: Objective: Skull base chordomas (SBC) are characterized by persistent progression. Conventional radiation following resection increases 5- and 10-year local control (LC) to 36 and 23 %, respectively. Patients treated with protons result in 10-year LC of 50 %. Brainstem dose constraints have inhibited higher prescription doses with photons. We reviewed our experience using high-dose fractionated stereotactic photon radiation therapy (HD-FSRT) to 81 Gy for SBC. Methods: We reviewed patients diagnosed with SBC and treated with radiation from 1999 to 2010. We excluded those with metastatic disease and prior radiation. Dose distributions and target volumes were obtained from radiation records. Results: Twelve patients met the search criteria. Median dose was 81 Gy (76.8–82.5) using a hyperfractionated regimen. Eleven patients with available data had median max and mean doses to the brainstem of 81 Gy (46.7–85.7) and 38 Gy (6.6–58.1). Mean target volume was 22 cm3 (5.3–193. 3). LC at 3 and 5 years was 69 and 46 %. Overall survival was 90 and 68 % with a mean follow-up of 55 months. There was a trend for improved LC in patients treated adjuvantly. Conclusion: HD-FSRT can achieve comparable doses to proton therapy plans, and preliminary results are an improvement from conventional photon therapy.Journal of Radiation Oncology. 03/2014; 3(1):57-64.