Gamma Knife surgery for skull base chordomas and chondrosarcomas

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  • Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
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Object

The purpose of this study was to evaluate radiosurgical outcomes in skull base chordomas and chondrosarcomas, and to determine which tumors are appropriate for stereotactic radiosurgery as adjuvant therapy following maximum tumor resection.

Methods

Thirty-seven patients (48 lesions) were treated using Gamma Knife surgery (GKS); 27 had chordomas, seven had chondrosarcomas, and three had radiologically diagnosed chordomas. The mean tumor volume was 20 ml, and the mean maximum and marginal doses were 28 and 14 Gy, respectively. The mean follow-up period was 97 months from diagnosis and 59 months from GKS.

Results

The actuarial 5- and 10-year survival rates after GKS were 80 and 53%, respectively. The actuarial 5- and 10-year local tumor control (LTC) rates after single or multiple GKS sessions were 76 and 67%, respectively. All patients with low-grade chondrosarcomas achieved good LTC. A tumor volume of less than 20 ml significantly affected the high rate of LTC (p = 0.0182). No patient had adverse radiation effects, other than one in whom facial numbness worsened despite successful tumor control.

Conclusions

As an adjuvant treatment after resection, GKS is a reasonable option for selected patients harboring skull base chordomas or chondrosarcomas with a residual tumor volume of less than 20 ml. Dose planning with a generous treatment volume to avoid marginal treatment failure should be made at a marginal dose of at least 15 Gy to achieve long-term tumor control.

Abbreviations used in this paper:GKS = Gamma Knife surgery; LTC = local tumor control; MR = magnetic resonance; PFS = progression-free survival.

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Contributor Notes

Address correspondence to: Toshinori Hasegawa, M.D., Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1–20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan. email: h-toshi@komakihp.gr.jp.
  • 1

    Arnold H, & Hermann HD: Skull base chordoma with cavernous sinus involvement. Partial or radical tumor-removal?. Acta Neurochir (Wien) 83:3137, 1986

    • Search Google Scholar
    • Export Citation
  • 2

    Austin-Seymour M, , Munzenrider J, , Goitein M, , Verhey L, , Urie M, & Gentry R, : Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull. J Neurosurg 70:1317, 1989

    • Search Google Scholar
    • Export Citation
  • 3

    Berson AM, , Castro JR, , Petti P, , Phillips TL, , Gauger GE, & Gutin P, : 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 15:559565, 1988

    • Search Google Scholar
    • Export Citation
  • 4

    Castro JR, , Linstadt DE, , Bahary JP, , Petti PL, , Daftari I, & Collier JM, : Experience in charged particle irradiation of tumors of the skull base: 1977–1992. Int J Radiat Oncol Biol Phys 29:647655, 1994

    • Search Google Scholar
    • Export Citation
  • 5

    Catton C, , O'Sullivan B, , Bell R, , Laperriere N, , Cummings B, & Fornasier V, : Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 41:6772, 1996

    • Search Google Scholar
    • Export Citation
  • 6

    Crockard HA, , Cheeseman A, , Steel T, , Revesz T, , Holton JL, & Plowman N, : A multidisciplinary team approach to skull base chondrosarcomas. J Neurosurg 95:184189, 2001

    • Search Google Scholar
    • Export Citation
  • 7

    Crockard HA, , Steel T, , Plowman N, , Singh A, , Crossman J, & Revesz T, : A multidisciplinary team approach to skull base chordomas. J Neurosurg 95:175183, 2001

    • Search Google Scholar
    • Export Citation
  • 8

    Cummings BJ, , Hodson DI, & Bush RS: Chordoma: the results of megavoltage radiation therapy. Int J Radiat Oncol Biol Phys 9:633642, 1983

  • 9

    Debus J, , Hug EB, , Liebsch NJ, , O'Farrel D, , Finkelstein D, & Efird J, : Brainstem tolerance to conformal radiotherapy of the skull base tumors. Int J Radiat Oncol Biol Phys 39:967975, 1997

    • Search Google Scholar
    • Export Citation
  • 10

    Fagundes MA, , Hug EB, , Liebsch NJ, , Daly W, , Efird J, & Munzenrider JE: Radiation therapy for chordomas of the base of skull and cervical spine: pattern of failure and outcome after relapse. Int J Radiat Oncol Biol Phys 33:579584, 1995

    • Search Google Scholar
    • Export Citation
  • 11

    Feigl GC, , Bundschuh O, , Gharabaghi A, , Safavi-Abassi S, , Shawarby A, & Samii M, : Evaluation of a new concept for the management of skull base chordomas and chondrosarcomas. J Neurosurg 102:Suppl 165170, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Fuller DB, & Bloom JG: Radiotherapy for chordoma. Int J Radiat Oncol Biol Phys 15:331339, 1988

  • 13

    Gay E, , Sekhar LN, , Rubinstein E, , Wright DC, , Sen C, & Janecka IP, : Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 36:887897, 1995

    • Search Google Scholar
    • Export Citation
  • 14

    Handa J, , Suzuki F, , Nioka H, & Koyama T: Clivus chordoma in childhood. Surg Neurol 28:5862, 1987

  • 15

    Hassounah M, , Al-Mefty O, , Akhtar M, , Jinkins JR, & Fox JL: Primary cranial and intracranial chondrosarcoma. A survey. Acta Neurochir (Wien) 78:123132, 1985

    • Search Google Scholar
    • Export Citation
  • 16

    Higginbotham NL, , Phillips RF, , Far HW, & Hustu HO: Chordoma. Thirty-five-year study at Memorial Hospital. Cancer 20:18411850, 1967

  • 17

    Hug EB, , Loredo LN, , Slater JD, , DeVries A, , Grove RI, & Schaefer RA, : Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 91:432439, 1999

    • Search Google Scholar
    • Export Citation
  • 18

    Kondziolka D, , Lunsford LD, & Flickinger JC: The role of radiosurgery in the management of chordoma and chondrosarcoma of the cranial base. Neurosurgery 29:3846, 1991

    • Search Google Scholar
    • Export Citation
  • 19

    Krishnan S, , Foote RL, , Brown PD, , Pollock BE, , Link MJ, & Garces YI: Radiosurgery for cranial base chordomas and chondrosarcomas. Neurosurgery 56:777784, 2005

    • Search Google Scholar
    • Export Citation
  • 20

    Meyers SP, , Hirsch WL, , Curtin HD, , Barnes L, , Sekhar LN, & Sen C: Chordomas of the skull base: MR features. AJNR Am J Neuroradiol 13:16271636, 1992

    • Search Google Scholar
    • Export Citation
  • 21

    Munzenrider JE, , Austin-Seymour M, , Blitzer PJ, , Gentry R, , Goitein M, & Gragoudas ES, : Proton therapy at Harvard. Strahlentherapie 161:756763, 1985

    • Search Google Scholar
    • Export Citation
  • 22

    Muthukumar N, , Kondziolka D, , Lunsford LD, & Flickinger JC: Stereotactic radiosurgery for chordoma and chondrosarcoma: further experiences. Int J Radiat Oncol Biol Phys 41:387392, 1998

    • Search Google Scholar
    • Export Citation
  • 23

    Noel G, , Habrand J, , Mammar H, , Pontvert D, , Haie-Meder C, & Hasboun D, : Combination of photon and proton radiation therapy for chordomas and chondrosarcomas of the skull base: the Centre de Protontherapie D'orsay experience. Int J Radiat Oncol Biol Phys 51:392398, 2001

    • Search Google Scholar
    • Export Citation
  • 24

    O'Connell JX, , Renard LG, , Liebsch NJ, , Efird JT, , Muzenrider JE, & Rosenberg AE: Base of skull chordoma. A correlative study of histologic and clinical features of 62 cases. Cancer 74:22612267, 1994

    • Search Google Scholar
    • Export Citation
  • 25

    Pamir MN, , Kiliç T, , Ture U, & Ozek MM: Multimodality management of 26 skull-base chordomas with 4-year mean follow-up: experience at a single institution. Acta Neurochir (Wien) 146:343354, 2004

    • Search Google Scholar
    • Export Citation
  • 26

    Pearlman AW, & Friedman M: Radical radiation therapy of chordoma. AJR Am J Roentgenol 108:332341, 1970

  • 27

    Raffel C, , Wright DC, , Gutin PH, & Wilson CB: Cranial chordomas: clinical presentation and results of operative and radiation therapy in twenty-six patients. Neurosurgery 17:703710, 1985

    • Search Google Scholar
    • Export Citation
  • 28

    Rich TA, , Schiller A, , Suit HD, & Mankin HJ: Clinical and pathologic review of 48 cases of chordoma. Cancer 56:182187, 1985

  • 29

    Santoni R, , Liebsch N, , Finkelstein DM, , Hug E, , Hanssens P, & Goitein M, : Temporal lobe (TL) damage following surgery and high-dose photon and proton irradiation in 96 patients affected by chordomas and chondrosarcomas of the base of the skull. Int J Radiat Oncol Biol Phys 41:5968, 1998

    • Search Google Scholar
    • Export Citation
  • 30

    Schulz-Ertner D, , Haberer T, , Jäkel O, , Thilmann C, , Krämer M, & Enghardt W, : Radiotherapy for chordomas and low-grade chondrosarcomas of the skull base with carbon ions. Int J Radiat Oncol Biol Phys 53:3642, 2002

    • Search Google Scholar
    • Export Citation
  • 31

    Tai PT, , Craighead P, & Bagdon F: Optimization of radiotherapy for patients with cranial chordoma. A review of dose-response for photon techniques. Cancer 75:749756, 1995

    • Search Google Scholar
    • Export Citation
  • 32

    Terahara A, , Niemierko A, , Goitein M, , Finkelstein D, , Hug E, & Liebsch N, : Analysis of the relationship between tumor dose inhomogeneity and local control in patients with skull base chordoma. Int J Radiat Oncol Biol Phys 45:351358, 1999

    • Search Google Scholar
    • Export Citation

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