Skip to main content

Advertisement

SpringerLink
Log in

Results of salvage treatment with CyberKnife® fractioned radiosurgery in recurrent large chordoma

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Aim

Chordomas and chondrosarcomas are locally destructive tumors with high progression or recurrence rates after initial multimodality treatment. This report examined the role of radiosurgery in patients who were considered inoperable after the recurrence of large chordoma disease having undergone previous surgery and/or radiotherapy.

Methods

All patients who were referred to Okmeydani Education and Research Hospital between 2012 and 2019 for treatment of recurrent or metastatic chordoma and considered not suitable for surgical treatment were included in the study. We included patients presenting with recurrent or metastatic chordoma, those who had undergone surgery and/or radiotherapy and were now considered to be surgically inoperable, patients whose tumors could lead to severe neurologic or organ dysfunction when resected, and those who underwent salvage treatments for definitive or palliative purposes with radiosurgery. After radiosurgical salvage therapy was performed on 13 patients using a CyberKnife® device, the effect of this treatment in terms of local control and survival and the factors that might affect it was investigated. Thirteen lesions were local (in-field) recurrence, and five lesions were closer to the primary tumor mass or seeding metastatic lesions. Tumor response was evaluated using the Response Evaluation Criteria for Solid Tumors (RECIST) system and volumetric analysis.

Results

The median age of the 13 patients was 59 years, and the median tumor volume of 18 lesions was 30.506 cc (R: 6884.06–150,418.519 mL). The median dose was 35 Gy (R: 17.5–47.5), the median fraction was 5 (R: 1–5), and the median biological effective dose BED2.45 was 135 Gy (R: 63.82–231.68). The median time for radiosurgery was 30 months after the first radiotherapy and 45 months after the last surgery. The median follow-up time was 57 (R: 15–94) months. The progression-free survival was 24 months. The median survival was 33.9 months. Local control was achieved in 84.6% of patients after 1 year, and 76.9% after 2 years, with the mass shrinking or remaining stable. Survival after recurrence was 69.2% for the 1st year, 61.5% for the 2nd year, and 53.8% for the 5th year.

Conclusion

In patients with recurrent and surgically inoperable chordomas, stereotactic body radiation therapy (SBRT) is a reliable and effective treatment method. Promising result has been obtained with radiosurgery treatment under local control of patients.

Level of evidence

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM (2001) Chordoma: incidence and survival patterns in the United States, 1973–1995. Cancer Causes Control 12:1–11. https://doi.org/10.1023/a:1008947301735

    Article  CAS  Google Scholar 

  2. Heffelfinger MJ, Dahlin DC, MacCarty CS, Beabout JW (1973) Chordomas and cartilaginous tumors at the skull base. Cancer 32:410–420. https://doi.org/10.1002/1097-0142(197308)32:2%3c410::aid-cncr2820320219%3e3.0.co;2-s

    Article  CAS  Google Scholar 

  3. Bethke KP, Neifeld JP, Lawrence W Jr (1991) Diagnosis and management of sacrococcygeal chordoma. J Surg Oncol 48:232–238. https://doi.org/10.1002/jso.2930480405

    Article  CAS  Google Scholar 

  4. Kaiser TE, Pritchard DJ, Unni KK (1984) Clinicopathologic study of sacrococcygeal chordoma. Cancer 53:2574–2578. https://doi.org/10.1002/1097-0142(19840601)53:11%3c2574::aid-cncr2820531136%3e3.0.co;2-5

    Article  CAS  Google Scholar 

  5. Fuller DB, Bloom JG (1988) Radiotherapy for chordoma. Int J Radiat Oncol Biol Phys 15:331–339. https://doi.org/10.1016/s0360-3016(98)90012-8

    Article  CAS  Google Scholar 

  6. Rich TA, Schiller A, Suit HD, Mankin HJ (1985) Clinical and pathologic review of 48 cases of chordoma. Cancer 56:182–187. https://doi.org/10.1002/1097-0142(19850701)56:1%3c182::aid-cncr2820560131%3e3.0.co;2-j

    Article  CAS  Google Scholar 

  7. Ozaki T, Hillmann A, Winkelmann W (1997) Surgical Treatment of sacrococcygeal chordoma. J Surg Oncol 64:274–279. https://doi.org/10.1002/(sici)1096-9098(199704)64:4%3c274::aid-jso5%3e3.0.co;2-6

    Article  CAS  Google Scholar 

  8. Denaro L, Berton A, Ciuffreda M, Loppini M, Candela V, Brandi ML, Longo UG (2020) Surgical management of chordoma: a systematic review. J Spinal Cord Med 43:797–812. https://doi.org/10.1080/10790268.2018.1483593

    Article  Google Scholar 

  9. Henderson FC, McCool K, Seigle J, Jean W, Harter W, Gagnon GJ (2009) Treatment of chordomas with CyberKnife: georgetown university experience and treatment recommendations. Neurosurgery 64:A44-53. https://doi.org/10.1227/01.Neu.0000341166.09107.47

    Article  Google Scholar 

  10. Klekamp J, Samii M (1996) Spinal chordomas–results of treatment over a 17-year period. Acta Neurochir (Wien) 138:514–519. https://doi.org/10.1007/bf01411170

    Article  CAS  Google Scholar 

  11. Verburg JM, Seco J (2013) Dosimetric accuracy of proton therapy for chordoma patients with titanium implants. Med Phys 40:071727. https://doi.org/10.1118/1.4810942

    Article  Google Scholar 

  12. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216. https://doi.org/10.1093/jnci/92.3.205

    Article  CAS  Google Scholar 

  13. Atkinson TM, Ryan SJ, Bennett AV, Stover AM, Saracino RM, Rogak LJ, Jewell ST, Matsoukas K, Li Y, Basch E (2016) The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review. Support Care Cancer 24:3669–3676. https://doi.org/10.1007/s00520-016-3297-9

    Article  Google Scholar 

  14. Duda P, Wiśniewski J, Wójtowicz T, Wójcicka O, Jaśkiewicz M, Drulis-Fajdasz D, Rakus D, McCubrey JA, Gizak A (2018) Targeting GSK3 signaling as a potential therapy of neurodegenerative diseases and aging. Expert Opin Ther Targets 22:833–848. https://doi.org/10.1080/14728222.2018.1526925

    Article  CAS  Google Scholar 

  15. Yan X, Li Z, Li H, Liu P, Zhao Z, Cheng S, Wang Z, Zhang Q (2019) Inhibition of glycogen synthase kinase 3 beta suppresses the growth and survival of skull base chordoma cells by downregulating brachyury expression. Onco Targets Ther 12:9783–9791. https://doi.org/10.2147/ott.S218930

    Article  CAS  Google Scholar 

  16. Jawad MU, Scully SP (2010) Surgery significantly improves survival in patients with chordoma. Spine (Phila Pa 1976) 35:117–123. doi: https://doi.org/10.1097/BRS.0b013e3181b44387

  17. Hanna SA, Aston WJ, Briggs TW, Cannon SR, Saifuddin A (2008) Sacral chordoma: Can local recurrence after sacrectomy be predicted? Clin Orthop Relat Res 466:2217–2223. https://doi.org/10.1007/s11999-008-0356-7

    Article  CAS  Google Scholar 

  18. Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ (2009) The surgical management of sacral chordomas. Spine 34:2700–2704. https://doi.org/10.1097/brs.0b013e3181bad11d

    Article  Google Scholar 

  19. Bergh P, Gunterberg B, Meis-Kindblom JM, Kindblom LG (2001) Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas: a center-based study of 69 cases. Cancer 91:1201–1212. https://doi.org/10.1002/1097-0142(20010401)91:7%3c1201::aid-cncr1120%3e3.0.co;2-w

    Article  CAS  Google Scholar 

  20. Ruggieri P, Angelini A, Ussia G, Montalti M, Mercuri M (2010) Surgical margins and local control in resection of sacral chordomas. Clin Orthop Relat Res 468:2939–2947. https://doi.org/10.1007/s11999-010-1472-8

    Article  Google Scholar 

  21. Stacchiotti S, Casali PG, Lo Vullo S, Mariani L, Palassini E, Mercuri M, Alberghini M, Pilotti S, Zanella L, Gronchi A, Picci P (2010) Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers. Ann Surg Oncol 17:211–219. https://doi.org/10.1245/s10434-009-0740-x

    Article  Google Scholar 

  22. York JE, Kaczaraj A, Abi-Said D, Fuller GN, Skibber JM, Janjan NA, Gokaslan ZL (1999) Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery 44:74–79. https://doi.org/10.1097/00006123-199901000-00041

    Article  CAS  Google Scholar 

  23. Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky JP, Weber KL, Suki D, Gallia GL, Garonzik I, Gokaslan ZL (2005) En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine 3:111–122. https://doi.org/10.3171/spi.2005.3.2.0111

    Article  Google Scholar 

  24. Gay E, Sekhar LN, Rubinstein E, Wright DC, Sen C, Janecka IP, Snyderman CH (1995) Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 36:887–896. https://doi.org/10.1227/00006123-199505000-00001

    Article  CAS  Google Scholar 

  25. Guo Y, Palmer JL, Shen L, Kaur G, Willey J, Zhang T, Bruera E, Wolinsky JP, Gokaslan ZL (2005) Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy. J Neurosurg Spine 3:106–110. https://doi.org/10.3171/spi.2005.3.2.0106

    Article  Google Scholar 

  26. Maira G, Pallini R, Anile C, Fernandez E, Salvinelli F, La Rocca LM, Rossi GF (1996) Surgical treatment of clival chordomas: the transsphenoidal approach revisited. J Neurosurg 85:784–792. https://doi.org/10.3171/jns.1996.85.5.0784

    Article  CAS  Google Scholar 

  27. Magrini SM, Papi MG, Marletta F, Tomaselli S, Cellai E, Mungai V, Biti G (1992) Chordoma-natural history, treatment and prognosis. The Florence Radiotherapy Department experience (1956–1990) and a critical review of the literature. Acta Oncol 31:847–851. https://doi.org/10.3109/02841869209089717

    Article  CAS  Google Scholar 

  28. Akmansu M, Kurt G, Demircan V, Senturk E (2020) Results of chordoma patients treated by different approaches in a single institution. Turk Neurosurg 30:366–370

    Google Scholar 

  29. Zorlu F, Gultekin M, Cengiz M, Yildiz F, Akyol F, Gurkaynak M, Ozyigit G (2014) Fractionated stereotactic radiosurgery treatment results for skull base chordomas. Technol Cancer Res Treat 13:11–19. https://doi.org/10.7785/tcrt.2012.500354

    Article  CAS  Google Scholar 

  30. Yamada Y, Laufer I, Cox BW, Lovelock DM, Maki RG, Zatcky JM, Boland PJ, Bilsky MH (2013) Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum. Neurosurgery 73:673–680. https://doi.org/10.1227/neu.0000000000000083

    Article  Google Scholar 

  31. Hug EB, Slater JD (2000) Proton radiation therapy for chordomas and chondrosarcomas of the skull base. Neurosurg Clin N Am 11:627–638

    Article  CAS  Google Scholar 

  32. Imai R, Kamada T, Araki N (2016) Carbon Ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases. Int J Radiat Oncol Biol Phys 95:322–327. https://doi.org/10.1016/j.ijrobp.2016.02.012

    Article  Google Scholar 

  33. Zhao J, Wang W, Shahnaz K, Wu X, Mao J, Li P, Zhang Q (2021) Dosimetric impact of using a commercial metal artifact reduction tool in carbon ion therapy in patients with hip prostheses. J Appl Clin Med Phys 22:224–234. https://doi.org/10.1002/acm2.13314

    Article  Google Scholar 

  34. Cahill J, Ibrahim R, Mezey G, Yianni J, Bhattacharyya D, Walton L, Grainger A, Radatz MWR (2021) Gamma Knife Stereotactic Radiosurgery for the treatment of chordomas and chondrosarcomas. Acta Neurochir (Wien) 163:1003–1011. https://doi.org/10.1007/s00701-021-04768-5

    Article  Google Scholar 

  35. Lockney DT, Shub T, Hopkins B, Lockney NA, Moussazadeh N, Lis E, Yamada Y, Schmitt AM, Higginson DS, Laufer I, Bilsky M (2017) Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment. Neurosurg Focus 42:E4. https://doi.org/10.3171/2016.9.Focus16373

    Article  Google Scholar 

  36. 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 68:379–389. https://doi.org/10.1227/NEU.0b013e3181ffa12c

    Article  Google Scholar 

  37. Hasegawa T, Ishii D, Kida Y, Yoshimoto M, Koike J, Iizuka H (2007) Gamma Knife surgery for skull base chordomas and chondrosarcomas. J Neurosurg 107:752–757

    Article  Google Scholar 

  38. Dassoulas K, Schlesinger D, Yen CP, Sheehan J (2009) The role of Gamma Knife surgery in the treatment of skull base chordomas. J Neurooncol 94:243–248

    Article  Google Scholar 

  39. Romero J, Cardenes H, la Torre A, Valcarcel F, Magallon R, Regueiro C, Aragon G (1993) Chordoma: results of radiation therapy in eighteen patients. Radiother Oncol 29:27–32. https://doi.org/10.1016/0167-8140(93)90169-9

    Article  CAS  Google Scholar 

  40. Jin CJ, Berry-Candelario J, Reiner AS, Laufer I, Higginson DS, Schmitt AM, Lis E, Barzilai O, Boland P, Yamada Y, Bilsky MH (2019) Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum. J Neurosurg Spine. https://doi.org/10.3171/2019.7.Spine19515

    Article  Google Scholar 

  41. Jung EW, Jung DL, Balagamwala EH, Angelov L, Suh JH, Djemil T, Magnelli A, Chao ST (2017) Single-fraction spine stereotactic body radiation therapy for the treatment of chordoma. Technol Cancer Res Treat 16:302–309. https://doi.org/10.1177/1533034616652775

    Article  Google Scholar 

Download references

Funding

No financial disclosure.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Prof. Dr. Cemil Tascioglu City Hospital (aka Okmeydani Education and Research Hospital), Kaptan Pasa No: 25, 34384 Şişli, Istanbul, Turkey

    Tanju Berber, Çakır Numanoğlu, Emre Uysal, Selvi Dinçer & Berna Akkuş Yıldırım

Authors
  1. Tanju Berber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Çakır Numanoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emre Uysal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Selvi Dinçer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Berna Akkuş Yıldırım
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tanju Berber.

Ethics declarations

Conflict of interest

No conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berber, T., Numanoğlu, Ç., Uysal, E. et al. Results of salvage treatment with CyberKnife® fractioned radiosurgery in recurrent large chordoma. Eur Spine J 32, 244–253 (2023). https://doi.org/10.1007/s00586-022-07399-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07399-1

Keywords

Search

Navigation