CyberKnife radiosurgery for the management of skull base and spinal chondrosarcomas
- 364 Downloads
The use of CyberKnife (CK) stereotactic radiosurgery (SRS) for the management of central nervous system chondrosarcomas has not been previously reported. To evaluate outcomes of primary, recurrent, and metastatic chondrosarcomas of the skull base and spine treated with CK SRS, a retrospective observational study of 16 patients treated between 1996 and 2011 with CK SRS was performed using an IRB-approved database at Stanford University Medical Center. Twenty lesions (12 cranial, 8 spinal) across six males and ten females were analyzed. The median age at SRS was 51 years and median follow-up was 33 months. Median tumor volume was 11.0 cm3 and median marginal dosages were 22, 24, 26, 27, and 30 Gy for one to five fractionations, respectively. Overall Kaplan–Meier survival rates were 88, 88, 80, and 66 % at 1, 3, 5, and 10 years after initial presentation. Survival rates at 1, 3, and 5 years after CK were 81, 67, and 55 %, respectively. Actuarial tumor control was 41 ± 13 % at 60 months. At 36 months follow-up, tumor control was 80 % in primary lesions, 50 % in recurrent lesions, and 0.0 % in metastatic disease (p = 0.07). Tumor control was 58 % in cranial lesions and 38 % in spinal lesions. Radiation injury was reported in one patient. CK SRS appears to be a safe adjuvant therapy and offers moderate control for primary cranial chondrosarcoma lesions. There appears to be a clinically, albeit not statistically, significant trend towards poorer outcomes in similarly treated metastatic, recurrent, and spinal chondrosarcomas (p = 0.07). Lesions not candidates for single fraction SRS may be treated with hypofractionated SRS without increased risk for radiation necrosis.
KeywordsChondrosarcoma Chordoma CyberKnife Stereotactic radiosurgery Gamma knife
Cassie Ludwig is acknowledged for her assistance with manuscript proofing and formatting.
Conflict of interest
The authors have no financial disclosures, ethical issues, or conflicts of interest to report.
- 3.Tzortzidis F, Elahi F, Wright DC, Temkin N, Natarajan SK, Sekhar LN (2006) Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chondrosarcomas. Neurosurgery 58(6):1090–1098. doi: 10.1227/01.NEU.0000215892.65663.54 discussion 1090–1098PubMedCrossRefGoogle Scholar
- 6.Bjornsson J, McLeod RA, Unni KK, Ilstrup DM, Pritchard DJ (1998) Primary chondrosarcoma of long bones and limb girdles. Cancer 83(10):2105–2119. doi: 10.1002/(SICI)1097-0142(19981115)83:10<2105:AID-CNCR9>3.0.CO;2-U PubMedCrossRefGoogle Scholar
- 10.Noel G, Habrand JL, Jauffret E, de Crevoisier R, Dederke S, Mammar H, Haie-Meder C, Pontvert D, Hasboun D, Ferrand R, Boisserie G, Beaudre A, Gaboriaud G, Guedea F, Petriz L, Mazeron JJ (2003) Radiation therapy for chordoma and chondrosarcoma of the skull base and the cervical spine. Prognostic factors and patterns of failure. Strahlenther Onkol 179(4):241–248. doi: 10.1007/s00066-003-1065-5 PubMedCrossRefGoogle Scholar
- 15.Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, Keall P, Lovelock M, Meeks S, Papiez L, Purdie T, Sadagopan R, Schell MC, Salter B, Schlesinger DJ, Shiu AS, Solberg T, Song DY, Stieber V, Timmerman R, Tome WA, Verellen D, Wang L, Yin FF (2010) Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys 37(8):4078–4101PubMedCrossRefGoogle Scholar
- 23.Foweraker KL, Burton KE, Maynard SE, Jena R, Jefferies SJ, Laing RJ, Burnet NG (2007) High-dose radiotherapy in the management of chordoma and chondrosarcoma of the skull base and cervical spine: part 1—clinical outcomes. Clin Oncol (R Coll Radiol) 19(7):509–516. doi: 10.1016/j.clon.2007.04.004 CrossRefGoogle Scholar