Stylianos Pikis1, Georgios Mantziaris1, Selcuk Peker2, Yavuz Samanci2, Ahmed M Nabeel3,4, Wael A Reda3,5, Sameh R Tawadros3,5, Amr M N El-Shehaby3,5, Khaled Abdelkarim3,5, Reem M Emad Eldin3,6, Darrah Sheehan1, Kimball Sheehan1, Roman Liscak7, Tomas Chytka7, Manjul Tripathi8, Renu Madan8, Herwin Speckter9, Wenceslao Hernández9, Gene H Barnett10, Yusuke S Hori10, Nisha Dabhi1, Salman Aldakhil11, David Mathieu11, Douglas Kondziolka12, Kenneth Bernstein13, Zhishuo Wei14, Ajay Niranjan14, Charles R Kersh15, L Dade Lunsford14, Jason P Sheehan1. 1. 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia. 2. 2Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey. 3. 3Gamma Knife Center Cairo, Nasser Institute, Cairo. 4. 4Department of Neurosurgery, Benha University, Benha. 5. 5Ain Shams University, Cairo. 6. 6Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt. 7. 7Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. 8. 8Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 9. 9Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic. 10. 10Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio. 11. 11Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada. 12. 12Department of Neurosurgery and. 13. 13Department of Radiation Oncology, New York University Langone, New York, New York. 14. 14Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and. 15. 15Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia.
Abstract
OBJECTIVE: The object of this study was to evaluate the safety, efficacy, and long-term outcomes of stereotactic radiosurgery (SRS) in the management of intracranial chordomas. METHODS: This retrospective multicenter study involved consecutive patients managed with single-session SRS for an intracranial chordoma at 10 participating centers. Radiological and neurological outcomes were assessed after SRS, and predictive factors were evaluated via statistical methodology. RESULTS: A total of 93 patients (56 males [60.2%], mean age 44.8 years [SD 16.6]) underwent single-session SRS for intracranial chordoma. SRS was utilized as adjuvant treatment in 77 (82.8%) cases, at recurrence in 13 (14.0%) cases, and as primary treatment in 3 (3.2%) cases. The mean tumor volume was 8 cm3 (SD 7.3), and the mean prescription volume was 9.1 cm3 (SD 8.7). The mean margin and maximum radiosurgical doses utilized were 17 Gy (SD 3.6) and 34.2 Gy (SD 6.4), respectively. On multivariate analysis, treatment failure due to tumor progression (p = 0.001) was associated with an increased risk for post-SRS neurological deterioration, and a maximum dose > 29 Gy (p = 0.006) was associated with a decreased risk. A maximum dose > 29 Gy was also associated with improved local tumor control (p = 0.02), whereas the presence of neurological deficits prior to SRS (p = 0.04) and an age > 65 years at SRS (p = 0.03) were associated with worse local tumor control. The 5- and 10-year tumor progression-free survival rates were 54.7% and 34.7%, respectively. An age > 65 years at SRS (p = 0.01) was associated with decreased overall survival. The 5- and 10-year overall survival rates were 83% and 70%, respectively. CONCLUSIONS: SRS appears to be a safe and relatively effective adjuvant management option for intracranial chordomas. The best outcomes were obtained in younger patients without significant neurological deficits. Further well-designed studies are necessary to define the best timing for the use of SRS in the multidisciplinary management of intracranial chordomas.
OBJECTIVE: The object of this study was to evaluate the safety, efficacy, and long-term outcomes of stereotactic radiosurgery (SRS) in the management of intracranial chordomas. METHODS: This retrospective multicenter study involved consecutive patients managed with single-session SRS for an intracranial chordoma at 10 participating centers. Radiological and neurological outcomes were assessed after SRS, and predictive factors were evaluated via statistical methodology. RESULTS: A total of 93 patients (56 males [60.2%], mean age 44.8 years [SD 16.6]) underwent single-session SRS for intracranial chordoma. SRS was utilized as adjuvant treatment in 77 (82.8%) cases, at recurrence in 13 (14.0%) cases, and as primary treatment in 3 (3.2%) cases. The mean tumor volume was 8 cm3 (SD 7.3), and the mean prescription volume was 9.1 cm3 (SD 8.7). The mean margin and maximum radiosurgical doses utilized were 17 Gy (SD 3.6) and 34.2 Gy (SD 6.4), respectively. On multivariate analysis, treatment failure due to tumor progression (p = 0.001) was associated with an increased risk for post-SRS neurological deterioration, and a maximum dose > 29 Gy (p = 0.006) was associated with a decreased risk. A maximum dose > 29 Gy was also associated with improved local tumor control (p = 0.02), whereas the presence of neurological deficits prior to SRS (p = 0.04) and an age > 65 years at SRS (p = 0.03) were associated with worse local tumor control. The 5- and 10-year tumor progression-free survival rates were 54.7% and 34.7%, respectively. An age > 65 years at SRS (p = 0.01) was associated with decreased overall survival. The 5- and 10-year overall survival rates were 83% and 70%, respectively. CONCLUSIONS: SRS appears to be a safe and relatively effective adjuvant management option for intracranial chordomas. The best outcomes were obtained in younger patients without significant neurological deficits. Further well-designed studies are necessary to define the best timing for the use of SRS in the multidisciplinary management of intracranial chordomas.