High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes

Purpose To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base. Methods Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary...

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Published in:	Journal of neuro-oncology Vol. 158; no. 1; pp. 23 - 31
Main Authors:	Chen, Andre Tsin Chih, Hong, Carlos Bo Chur, Narazaki, Douglas Kenji, Rubin, Virginio, Serante, Alexandre Ruggieri, Ribeiro Junior, Ulysses, de Lima, Luiz Guilherme Cernaglia Aureliano, Coimbra, Brian Guilherme Monteiro Marta, Cristante, Alexandre Fogaça, Teixeira, William Gemio Jacobsen
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-05-2022 Springer Nature B.V
Subjects:	Chordoma - diagnostic imaging Chordoma - pathology Chordoma - radiotherapy Humans Immunoglobulins Medicine Medicine & Public Health Metastases Metastasis Middle Aged Neurology Oncology Patients Radiation therapy Radiotherapy, Intensity-Modulated - adverse effects Retrospective Studies Sacrum Sacrum - pathology Skull Skull Base Spine (lumbar) Surgery Survival Treatment Outcome Tumors Chordoma Intensity modulated radiation therapy (IMRT) Photon
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Summary:	Purpose To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base. Methods Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure. Results A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63). Conclusion Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0167-594X 1573-7373
DOI:	10.1007/s11060-022-04003-w