Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum

Yamada, Y., Laufer, I., Cox, B. W., Lovelock, D. M., Maki, R. G., Zatcky, J. M., Boland, P. J., Bilsky, M. H. (October 2013) Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum. Neurosurgery, 73 (4). 673-80; discussion 680. ISSN 1524-4040 (Electronic)0148-396X (Linking)

DOI: 10.1227/NEU.0000000000000083


BACKGROUND: En bloc wide-margin excision significantly decreases the risk of chordoma recurrence. However, a wide surgical margin cannot be obtained in many chordomas because they arise primarily in the sacrum, clivus, and mobile spine. Furthermore, these tumors have shown resistance to fractionated photon radiation at conventional doses and numerous chemotherapies. OBJECTIVE: To analyze the outcomes of single-fraction stereotactic radiosurgery (SRS) in the treatment of chordomas of the mobile spine and sacrum. METHODS: Twenty-four patients with chordoma of the sacrum and mobile spine were treated with high-dose single-fraction SRS (median dose, 2400 cGy). Twenty-one primary and 3 metastatic tumors were treated. Seven patients were treated for postoperative tumor recurrence. In 7 patients, SRS was administered as planned adjuvant therapy, and in 13 patients, SRS was administered as neoadjuvant therapy. All patients had serial magnetic resonance imaging follow-up. RESULTS: The overall median follow-up was 24 months. Of the 24 patients, 23 (95%) demonstrated stable or reduced tumor burden based on serial magnetic resonance imaging. One patient had radiographic progression of tumor 11 months after SRS. Only 6 of 13 patients who underwent neoadjuvant SRS proceeded to surgery. This decision was based on the lack of radiographic progression and the patient's preference. Complications were limited to 1 patient in whom sciatic neuropathy developed and 1 with vocal cord paralysis. CONCLUSION: High-dose single-fraction SRS provides good tumor control with low treatment-related morbidity. Additional follow-up is required to determine the long-term recurrence risk.

Item Type: Paper
Uncontrolled Keywords: Adult Aged Aged, 80 and over Chordoma/mortality/pathology/*radiotherapy Cohort Studies Female Humans Male Middle Aged Neoplasm Recurrence, Local/pathology/radiotherapy Radiosurgery/*methods Retrospective Studies Sacrum/*pathology Spinal Neoplasms/mortality/pathology/*radiotherapy Treatment Outcome
Subjects: diseases & disorders > cancer
Investigative techniques and equipment > radiation treatment and equipment
CSHL Authors:
Communities: CSHL labs > Maki lab
Depositing User: Matt Covey
Date: October 2013
Date Deposited: 20 Oct 2016 15:42
Last Modified: 20 Oct 2016 15:42
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