Radiosurgery for chordomas and chondrosarcomas of the skull base

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Object

Chordomas and chondrosarcomas of the skull base are aggressive and locally destructive tumors with a high tendency for local progression despite treatment. The authors evaluated the effect of stereotactic radiosurgery (SRS) on local tumor control and survival.

Methods

Twenty-eight patients with histologically confirmed chordomas (18) or chondrosarcomas (10) underwent Gamma Knife SRS either as primary or adjuvant treatment. Their ages ranged from 17 to 72 years (median 44 years). The most common presenting symptom was diplopia (26 patients, 93%). In two patients, SRS was the sole treatment. Twenty-six patients underwent between one and five additional surgical procedures. Two underwent an initial trans-sphenoidal biopsy. The average tumor volume was 9.8 cm3. The median dose to the tumor margin was 16 Gy.

Results

No patient was lost to follow-up. Transient symptomatic adverse radiation effects developed in only one patient. The actuarial local tumor control for chondrosarcomas at 5 years was 80 ± 10.1%. For chordomas both the actuarial tumor control and survival was 62.9 ± 10.4%.

Conclusions

Stereotactic radiosurgery is an important option for skull base chordomas and chondrosarcomas either as primary or adjunctive treatment. Multimodal management appears crucial to improve tumor control in most patients.

Abbreviations used in this paper:CGE = cobalt gray equivalent; CT = computed tomography; long-TR = long relaxation repetition time; MR = magnetic resonance; PBRT = proton-beam radiation therapy; SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: L. Dade Lunsford, M.D., Suite B-400, University of Pittsburgh Medical Center–Presbyterian, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. email: lunsfordld@upmc.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Axial contrast-enhanced T1-weighted MR images showing a residual chondrosarcoma at the time of radiosurgery (left) and significant regression of the treated lesion at 78 months (right). This patient died of malignant metastatic melanoma.

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    Kaplan–Meier plot showing tumor control after radiosurgery for skull base chondrosarcomas.

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    Axial (A and C) and coronal (B and D) T1-weighted contrast-enhanced MR images. A and B: A recurrent chordoma is revealed in a patient who had third, fourth, and sixth cranial nerve palsies and upper-extremity Grade 3 weakness, related to a left cavernous sinus and upper clivus lesion at the time of radiosurgery. C and D: Images obtained at 144-month follow-up showing regression of the tumor. This patient had complete resolution of cranial nerve deficits and improvement in right upper-extremity motor function.

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    Kaplan–Meier plot showing tumor control after a single SRS procedure for skull base chordomas.

  • View in gallery

    Kaplan–Meier plot showing tumor control and survival after single or repeated SRS (three patients) for skull base chordomas.

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