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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)

Also available at
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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
 

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