Preliminary experience in treating skull base chordomas with high-dose hyperfractionated stereotactic photon radiation therapy
Skull base chordomas (SBC) are characterized by persistent progression. Conventional radiation following resection increases 5- and 10-year local control (LC) to 36 and 23 %, respectively. Patients treated with protons result in 10-year LC of 50 %. Brainstem dose constraints have inhibited higher prescription doses with photons. We reviewed our experience using high-dose fractionated stereotactic photon radiation therapy (HD-FSRT) to 81 Gy for SBC.
We reviewed patients diagnosed with SBC and treated with radiation from 1999 to 2010. We excluded those with metastatic disease and prior radiation. Dose distributions and target volumes were obtained from radiation records.
Twelve patients met the search criteria. Median dose was 81 Gy (76.8–82.5) using a hyperfractionated regimen. Eleven patients with available data had median max and mean doses to the brainstem of 81 Gy (46.7–85.7) and 38 Gy (6.6–58.1). Mean target volume was 22 cm3 (5.3–193. 3). LC at 3 and 5 years was 69 and 46 %. Overall survival was 90 and 68 % with a mean follow-up of 55 months. There was a trend for improved LC in patients treated adjuvantly.
HD-FSRT can achieve comparable doses to proton therapy plans, and preliminary results are an improvement from conventional photon therapy.
KeywordsChordoma Radiation Clivus
Conflict of interest
Arshin Sheybani, Raheel Ahmed, Mindi J TenNapel, Edward C Pennington, Daniel E Hyer, Kathleen M Anderson, Arnold H Menezes, Patrick Hitchon, and John M Buatti declare that no actual or potential conflict of interest exists in relation to the publication of this manuscript.
Ethical standards statement
Institutional Review Board approval was obtained for this retrospective study. This retrospective series does not contain any studies with human tissues or animal subjects performed by any of the authors.
- 8.Gunderson LL, Tepper JE (2007) Clinical radiation oncology, 2nd edn. Elsevier, PhiladelphiaGoogle Scholar
- 11.Tai PT, Craighead P, Bagdon F (1995) Optimization of radiotherapy for patients with cranial chordoma. A review of dose-response ratios for photon techniques Cancer 75(3):749–756Google Scholar
- 16.Park L, Delaney TF, Liebsch NJ, Hornicek FJ, Goldberg S, Mankin H, Rosenberg AE, Rosenthal DI, Suit HD (2006) Sacral chordomas: impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor. Int J Radiat Oncol Biol Phys 65(5):1514–1521. doi: 10.1016/j.ijrobp.2006.02.059 PubMedCrossRefGoogle Scholar
- 18.Ares C, Hug EB, Lomax AJ, Bolsi A, Timmermann B, Rutz HP, Schuller JC, Pedroni E, Goitein G (2009) Effectiveness and safety of spot scanning proton radiation therapy for chordomas and chondrosarcomas of the skull base: first long-term report. Int J Radiat Oncol Biol Phys 75(4):1111–1118. doi: 10.1016/j.ijrobp.2008.12.055 PubMedCrossRefGoogle Scholar
- 21.Jiang B, Veeravagu A, Lee M, Harsh GR, Lieberson RE, Bhatti I, Soltys SG, Gibbs IC, Adler JR, Chang SD (2012) Management of intracranial and extracranial chordomas with CyberKnife stereotactic radiosurgery. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia 19(8):1101–1106. doi: 10.1016/j.jocn.2012.01.005 CrossRefGoogle Scholar
- 25.Kano H, Iqbal FO, Sheehan J, Mathieu D, Seymour ZA, Niranjan A, Flickinger JC, Kondziolka D, Pollock BE, Rosseau G, Sneed PK, McDermott MW, Lunsford LD (2011) Stereotactic radiosurgery for chordoma: a report from the North American Gamma Knife Consortium. Neurosurgery 68(2):379–389. doi: 10.1227/NEU.0b013e3181ffa12c PubMedCrossRefGoogle Scholar
- 27.Hauptman JS, Barkhoudarian G, Safaee M, Gorgulho A, Tenn S, Agazaryan N, Selch M, De Salles AA (2012) Challenges in linear accelerator radiotherapy for chordomas and chondrosarcomas of the skull base: focus on complications. Int J Radiat Oncol Biol Phys 83(2):542–551. doi: 10.1016/j.ijrobp.2011.08.004 PubMedGoogle Scholar
- 29.Hall EJ, Giaccia AJ (2006) Radiobiology for the radiologist, 6th edn. Lippincott Williams & Wilkins, Philadelphia, PAGoogle Scholar
- 33.Berson AM, Castro JR, Petti P, Phillips TL, Gauger GE, Gutin P, Collier JM, Henderson SD, Baken K (1988) Charged particle irradiation of chordoma and chondrosarcoma of the base of skull and cervical spine: the Lawrence Berkeley Laboratory experience. Int J Radiat Oncol Biol Phys 15(3):559–565PubMedCrossRefGoogle Scholar
- 37.Terahara A, Niemierko A, Goitein M, Finkelstein D, Hug E, Liebsch N, O'Farrell D, Lyons S, Munzenrider J (1999) Analysis of the relationship between tumor dose inhomogeneity and local control in patients with skull base chordoma. Int J Radiat Oncol Biol Phys 45(2):351–358PubMedCrossRefGoogle Scholar
- 38.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
- 39.Potluri S, Jefferies SJ, Jena R, Harris F, Burton KE, Prevost AT, Burnet NG (2011) Residual postoperative tumour volume predicts outcome after high-dose radiotherapy for chordoma and chondrosarcoma of the skull base and spine. Clin Oncol (R Coll Radiol) 23(3):199–208. doi: 10.1016/j.clon.2010.09.011 CrossRefGoogle Scholar