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

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

doi:10.1055/s-0035-1554907

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

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

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

Sergei Terterov

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

Nolan Ung

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

Tania Kaprealian

²Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States

,

Andy Trang

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

Antonio DeSalles

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

Lawrance K. Chung

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

Neil Martin

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

Michael Selch

²Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States

,

Marvin Bergsneider

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

,

William Yong

³Department of Pathology, University of California Los Angeles, Los Angeles, California, United States

,

Isaac Yang

¹Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

⁴Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, United States

› Author Affiliations

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.

Keywords

chordoma - radiosurgery - radiation therapy - surgery - prognostic factors

Full Text

References

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