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

Choy, Winward; Terterov, Sergei; Ung, Nolan; Kaprealian, Tania; Trang, Andy; DeSalles, Antonio; Chung, Lawrance K.; Martin, Neil A.; Selch, Michael T.; Bergsneider, Marvin; Yong, William H.; Yang, Isaac

doi:10.1055/s-0035-1554907

Cited by 18 publications

(21 citation statements)

References 57 publications

(74 reference statements)

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“…11,18 On univariate analysis, older patients had better PFS, which is incongruent with some studies which showed younger age is usually a positive prognostic factor. 20,[26][27][28] However, some publications showed no correlation with age 11,[29][30][31] while others showed older age had better outcomes. 32,33 In our analysis, this correlation did not stay significant on multivariate analysis and may be due to other confounding factors in our population.…”

Section: Discussionmentioning

confidence: 99%

“…12,14,19 Radiation techniques for salvage therapies included GKRS, CKRS, proton therapy, carbon ion therapy, and LINAC-based SRS with recurrence rates ranging from 36 to 85%. 13,15,17,18,20 Bugoci et al from Kaiser, Los Angeles described novel therapy using molecular targets, including agents such as Gleevec and Dasatinib, with two out of three patients alive with stable disease after at least 30 months of therapy. 16 Attempts for meaningful comparisons between these different treatment algorithms are limited due to differences in patient population, tumor characteristics, and reported outcome measures.…”

Section: Discussionmentioning

confidence: 99%

“…10 Few studies have reported outcomes with management of locally relapsed disease with either surgery or radiation. [11][12][13][14][15][16][17][18][19][20][21] In the recurrent setting, stereotactic radiosurgery (SRS) is an attractive option for chordomas and other skull base tumors given its high conformality, high biologically equivalent dose, and few treatments. [22][23][24] At our tertiary academic medical center, we have experience treating recurrent chordomas of the skull base with either salvage re-resection or radiotherapy using Gamma Knife radiosurgery (GKRS) or CyberKnife radiosurgery (CKRS).…”

Section: Introductionmentioning

confidence: 99%

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Use of Salvage Surgery or Stereotactic Radiosurgery for Multiply Recurrent Skull Base Chordomas: A Single-Institution Experience and Review of the Literature

Yoo

Strickland

Zada

et al. 2020

J Neurol Surg B Skull Base

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Introduction Chordomas are locally destructive neoplasms characterized by appreciable recurrence rates after initial multimodality treatment. We examined the outcome of salvage treatment in recurrent/progressive skull base chordomas. Methods This is a retrospective review of recurrent/progressive skull base chordomas at a tertiary urban academic medical center. The outcomes evaluated were overall survival, progression-free survival (PFS), and incidence of new toxicity. Results Eighteen consecutive patients who underwent ≥1 course of treatment (35.3% salvage surgery, 23.5% salvage radiation, and 41.2% both) were included. The median follow-up was 98.6 months (range 16–215 months). After initial treatment, the median PFS was 17.7 months (95% confidence interval [CI]: 4.9–22.6 months). Following initial therapy, age ≥ 40 had improved PFS on univariate analysis (p = 0.03). All patients had local recurrence, with 15 undergoing salvage surgical resections and 16 undergoing salvage radiation treatments (mostly stereotactic radiosurgery [SRS]). The median PFS was 59.2 months (95% CI: 4.0–99.3 months) after salvage surgery, 58.4 months (95% CI: 25.9–195 months) after salvage radiation, and 58.4 months (95% CI: 25.9.0–98.4 months) combined. Overall survival for the total cohort was 98.7% ± 1.7% at 2 years and 92.8% ± 5.5% at 5 years. Salvage treatments were well-tolerated with two patients (11%) reporting tinnitus and one patient each (6%) reporting headaches, visual field deficits, hearing loss, anosmia, dysphagia, or memory loss. Conclusion Refractory skull base chordomas present a challenging treatment dilemma. Repeat surgical resection or SRS seems to provide adequate salvage therapy that is well-tolerated when treated at a tertiary center offering multimodality care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of Salvage Surgery or Stereotactic Radiosurgery for Multiply Recurrent Skull Base Chordomas: A Single-Institution Experience and Review of the Literature

Yoo

Strickland

Zada

et al. 2020

J Neurol Surg B Skull Base

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“…Using CRT at median doses of up to 60 Gy, a few studies report a local control at 5 years in the range of 17-41% [96][97][98][99]. New radiation techniques, including both IMRT and FSRT, which allow higher doses of radiation to the tumour while sparing more surrounding normal tissue, have been associated with better outcome (Table 4) [100,101]. Using IMRT with a median dose of 76 Gy given in 2 Gy per fraction in 24 patients, Sahgal et al [100] reported a 5-year survival and local control rates of 85.6 and 65.3%, respec-tively, at a median follow-up of 36 months.…”

Section: Chordoma and Chondrosarcomamentioning

confidence: 99%

Radiotherapy of Parasellar Tumours

et al. 2020

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Parasellar tumours represent a wide group of intracranial lesions, both benign and malignant. They may arise from several structures located within the parasellar area or they may infiltrate or metastasize this region. The treatment of the tumours located in these areas is challenging because of their complex anatomical location and their heterogenous histology. It often requires a multimodal approach, including surgery, radiation therapy (RT), and medical therapy. Due to the proximity of critical structures and the risks of side effects related to the procedure, a successful surgical resection is often not achievable. Thus, RT plays a crucial role in the treatment of several parasellar tumours. Conventional fractionated RT and modern radiation techniques, like stereotactic radiosurgery and proton beam RT, have become a standard management option, in particular for cases with residual or recurrent tumours after surgery and for those cases where surgery is contraindicated. This review examines the role of RT in parasellar tumours analysing several techniques, outcomes and side effects.

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“…Given these tumors' aggressiveness and the risk involved with a true total resection, the recurrence rate remains significant. The use of adjuvant radiation maximizes tumor control and neurological preservation [1]. Careful planning and reduction of dose delivered to adjacent critical structures are important considerations [3].…”

mentioning

confidence: 99%

Endoscopic endonasal approach for intracranial chordomas

Chakraborty

Dehdashti

2016

Acta Neurochir

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The goal of any neurosurgical procedure for tumor removal involves balancing the morbidity of the operation and necessity for total resection of the tumor. This calculation becomes especially complex in regard to chordomas-relatively slowgrowing tumors, which can have devastating effects if either untreated, or improperly resected. As tumors arising from notochordal remnants, chordomas are found at the skull-base and upper spine, and at the sacrococcygeal junction. Caudal end tumors are often best treated with en-bloc resection; however, this is often not possible for skull-base tumors. Traditionally, for intracranial or skull-base chordomas, complex craniofacial procedures with high morbidity were often needed for removal, and even so often left residuals that led towards recurrence. A real gross total resection of the vast majority of chordomas is impossible, hence the reason for recurrence.Over the past decade, the endoscopic endonasal technique, advances in instrumentation, improvements in neuroimaging, operative guidance systems, and intraoperative imaging have revolutionized skull base surgery and the treatment of these tumors. In their article, Shimony et al. [7] describe their evolution of practice in treating skull base chordomas with 17 endoscopic endonasal and 7 craniotomy procedures in 18 patients. Keeping in line with much of the recent literature, Shimony et al. found that tumors involving the midline from the sella to the first cervical vertebra are likely best approached via an endoscopic transphenoidal approach. The limitation of this technique are more laterally extending tumors. Tumors that extend into the lateral compartment of cavernous sinus, beyond the lateral carotid line, or lateral to the petrous apex are especially difficult to visualize, even with angled endoscopes, and are often unresectable via a pure endonasal route and necessitated further approaches/treatment. Tumors of the lower third of the clivus were found to be difficult to fully treat with this approach in their series. They concluded a 33% gross total resection based on the surgical team's assessment, but the volumetric analyses did not confirm gross total resection in any cases. This is in line with our philosophy that a true gross total resection is rarely feasible in intracranial chordomas.Cranial nerve deficits are common in chordoma surgery and neurovascular structures are at greater risk. Sen et al. [5] had a gross total resection rate of over 85% (18 out of 21) in an earlier craniotomy series, but with a complication rate approaching 25% when evaluating the cranial nerve function and cerebrospinal fluid (CSF) leak, and so on. Their newer report on 71 patients had grossly comparable results with 21% CSF leak rate [6]. Sekhar et al.[4] achieved a 59% gross total resection for the price of 21% new cranial nerve deficit and 26% CSF leak rate in another craniotomy based series. In their study, Shimony et al. [7] achieved a 33% gross total resection (not confirmed by volumetric analyses), and a similar complication rate, ...

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

Cited by 18 publications

References 57 publications

Use of Salvage Surgery or Stereotactic Radiosurgery for Multiply Recurrent Skull Base Chordomas: A Single-Institution Experience and Review of the Literature

Use of Salvage Surgery or Stereotactic Radiosurgery for Multiply Recurrent Skull Base Chordomas: A Single-Institution Experience and Review of the Literature

Radiotherapy of Parasellar Tumours

Endoscopic endonasal approach for intracranial chordomas

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