Outcomes of Gamma Knife radiosurgery for skull base chondrosarcomas: a multi-institutional retrospective study

Mariko KawashimaDepartment of Neurosurgery, The University of Tokyo Hospital, Tokyo;

Search for other papers by Mariko Kawashima in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Masahiro ShinDepartment of Neurosurgery, The University of Tokyo Hospital, Tokyo;

Search for other papers by Masahiro Shin in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Hidefumi JokuraJiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Miyagi;

Search for other papers by Hidefumi Jokura in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Toshinori HasegawaDepartment of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Aichi;

Search for other papers by Toshinori Hasegawa in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Kazuhiro YamanakaDepartment of Neurosurgery, Osaka City General Hospital, Osaka;

Search for other papers by Kazuhiro Yamanaka in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Masaaki YamamotoKatsuta Hospital Mito GammaHouse, Hitachi-naka, Ibaraki;

Search for other papers by Masaaki Yamamoto in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Shigeo MatsunagaDepartment of Neurosurgery and Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Kanagawa;

Search for other papers by Shigeo Matsunaga in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Atsuya AkabaneGamma Knife Center, NTT Medical Center Tokyo;

Search for other papers by Atsuya Akabane in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Shoji YomoDivision of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Nagano;

Search for other papers by Shoji Yomo in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Shinji OnoueDepartment of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime;

Search for other papers by Shinji Onoue in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Takeshi KondohDepartment of Neurosurgery, Shinsuma General Hospital, Kobe, Hyogo, Japan

Search for other papers by Takeshi Kondoh in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Hirotaka HasegawaDepartment of Neurosurgery, The University of Tokyo Hospital, Tokyo;

Search for other papers by Hirotaka Hasegawa in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Yuki ShinyaDepartment of Neurosurgery, The University of Tokyo Hospital, Tokyo;

Search for other papers by Yuki Shinya in
Current site
Google Scholar
PubMed
Close
 MD
, and
Nobuhito SaitoDepartment of Neurosurgery, The University of Tokyo Hospital, Tokyo;

Search for other papers by Nobuhito Saito in
Current site
Google Scholar
PubMed
Close
 MD, PhD
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

OBJECTIVE

Radiotherapy has an essential role in the management of skull base chondrosarcomas (SBCs) after resection. This multi-institutional study evaluated the outcomes of Gamma Knife radiosurgery (GKRS) for histopathologically proven SBCs.

METHODS

Data of patients who underwent GKRS for SBCs at Gamma Knife centers in Japan were retrospectively collected. Patients without a histopathological diagnosis and those who had intracranial metastases from extracranial chondrosarcomas were excluded. Histologically, grade III and some nonconventional variants were identified as aggressive types. The cumulative local control rates (LCRs) and disease-specific survival (DSS) rates were calculated using the Kaplan-Meier method. Factors potentially affecting the LCR were evaluated using the Cox proportional hazards model for bivariate and multivariate analyses. The incidence of radiation-induced adverse effects (RAEs) was calculated as crude rates, and factors associated with RAEs were examined using Fisher’s exact test.

RESULTS

Fifty-one patients were enrolled, with a median age of 38 years. Thirty patients (59%) were treated with upfront GKRS for residual SBCs after resection (n = 27) or biopsy (n = 3), and 21 (41%) underwent GKRS as a salvage treatment for recurrence. The median tumor volume was 8 cm3. The overall LCRs were 87% at 3 years, 78% at 5 years, and 67% at 10 years after GKRS. A better LCR was associated with a higher prescription dose (p = 0.039) and no history of repeated recurrence before GKRS (p = 0.024). The LCRs among patients with the nonaggressive histological type and treatment with ≥ 16 Gy were 88% at 3 years, 83% at 5 years, and 83% at 10 years. The overall survival rates after GKRS were 96% at 5 years and 83% at 10 years. Although RAEs were observed in 3 patients (6%), no severe RAEs with Common Terminology Criteria for Adverse Events grade 3 or higher were identified. No significant factor was associated with RAEs.

CONCLUSIONS

GKRS for SBCs has a favorably low risk of RAEs and could be a reasonable therapeutic option for SBC in multimodality management. A sufficient GKRS prescription dose is necessary for higher LCRs. Histological grading and subtype evaluations are important for excluding exceptional SBCs. Patients with conventional SBCs have a long life expectancy and should be observed for life after treatment.

ABBREVIATIONS

CI = confidence interval; CTCAE = Common Terminology Criteria for Adverse Events; DSS = disease-specific survival; GKRS = Gamma Knife radiosurgery; HR = hazard ratio; ICR = intracranial control rate; LCR = local control rate; PTV = planning target volume; RAE = radiation-induced adverse effect; SBC = skull base chondrosarcoma.
  • Collapse
  • Expand

Illustration from Di Somma et al. (pp 1187–1190). Published with permission from Glia Media | Artist: Martha Headworth, MS.

  • 1

    Rapidis AD, Archondakis G, Anteriotis D, Skouteris CA. Chondrosarcomas of the skull base: review of the literature and report of two cases. J Craniomaxillofac Surg. 1997;25(6):322327.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Cianfriglia F, Pompili A, Occhipinti E. Intracranial malignant cartilaginous tumours. Report of two cases and review of literature. Acta Neurochir (Wien). 1978;45(1-2):163175.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Bloch OG, Jian BJ, Yang I, et al. A systematic review of intracranial chondrosarcoma and survival. J Clin Neurosci. 2009;16(12):15471551.

  • 4

    Awad M, Gogos AJ, Kaye AH. Skull base chondrosarcoma. J Clin Neurosci. 2016;24:15.

  • 5

    Ma X, Meng G, Wang K, et al. The differences between intracranial mesenchymal chondrosarcoma and conventional chondrosarcoma in clinical features and outcomes. World Neurosurg. 2019;122:e1078e1082.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Amer KM, Munn M, Congiusta D, Abraham JA, Basu Mallick A. Survival and prognosis of chondrosarcoma subtypes: SEER database analysis. J Orthop Res. 2020;38(2):311319.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Murakami Y, Jinguji S, Kishida Y, et al. Multiple surgical treatments for repeated recurrence of skull base mesenchymal chondrosarcoma. NMC Case Rep J. 2018;5(4):99103.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Oghalai JS, Buxbaum JL, Jackler RK, McDermott MW. Skull base chondrosarcoma originating from the petroclival junction. Otol Neurotol. 2005;26(5):10521060.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Raza SM, Gidley PW, Meis JM, Grosshans DR, Bell D, DeMonte F. Multimodality treatment of skull base chondrosarcomas: the role of histology specific treatment protocols. Neurosurgery. 2017;81(3):520530.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Venteicher AS, McDowell MM, Goldschmidt E, Wang EW, Snyderman CH, Gardner PA. A preoperative risk classifier that predicts tumor progression in patients with cranial base chondrosarcomas. J Neurosurg. 2021;134(2):457465.

    • Search Google Scholar
    • Export Citation
  • 11

    Carlson ML, O’Connell BP, Breen JT, et al. Petroclival chondrosarcoma: a multicenter review of 55 cases and new staging system. Otol Neurotol. 2016;37(7):940950.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    De Amorim Bernstein K, DeLaney T. Chordomas and chondrosarcomas—the role of radiation therapy. J Surg Oncol. 2016;114(5):564569.

  • 13

    Holtzman AL, Rotondo RL, Rutenberg MS, et al. Proton therapy for skull-base chondrosarcoma, a single-institution outcomes study. J Neurooncol. 2019;142(3):557563.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Baumann BC, Lustig RA, Mazzoni S, et al. A prospective clinical trial of proton therapy for chordoma and chondrosarcoma: feasibility assessment. J Surg Oncol. 2019;120(2):200205.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Hug EB, Loredo LN, Slater JD, et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg. 1999;91(3):432439.

  • 16

    Noël G, Feuvret L, Ferrand R, Boisserie G, Mazeron JJ, Habrand JL. Radiotherapeutic factors in the management of cervical-basal chordomas and chondrosarcomas. Neurosurgery. 2004;55(6):12521262.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Weber DC, Badiyan S, Malyapa R, et al. Long-term outcomes and prognostic factors of skull-base chondrosarcoma patients treated with pencil-beam scanning proton therapy at the Paul Scherrer Institute. Neuro Oncol. 2016;18(2):236243.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Almefty K, Pravdenkova S, Colli BO, Al-Mefty O, Gokden M. Chordoma and chondrosarcoma: similar, but quite different, skull base tumors. Cancer. 2007;110(11):24572467.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Müller U, Kubik-Huch RA, Ares C, et al. Is there a role for conventional MRI and MR diffusion-weighted imaging for distinction of skull base chordoma and chondrosarcoma?. Acta Radiol. 2016;57(2):225232.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Stacchiotti S, Sommer J;Chordoma Global Consensus Group. Building a global consensus approach to chordoma: a position paper from the medical and patient community. Lancet Oncol. 2015;16(2):e71e83.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Iannalfi A, D’Ippolito E, Riva G, et al. Proton and carbon ion radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy. Neuro Oncol. 2020;22(9):13481358.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Ares C, Hug EB, Lomax AJ, et al. 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. 2009;75(4):11111118.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Faramand A, Kano H, Niranjan A, Park KJ, Flickinger JC, Lunsford LD. Tumor control and cranial nerve outcomes after adjuvant radiosurgery for low-grade skull base meningiomas. World Neurosurg. 2019;127:e221e229.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Hasegawa T, Kato T, Naito T, et al. Long-term outcomes of sporadic vestibular schwannomas treated with recent stereotactic radiosurgery techniques. Int J Radiat Oncol Biol Phys. 2020;108(3):725733.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol. 1990;8(7):12771280.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Cahill J, Ibrahim R, Mezey G, et al. Gamma Knife stereotactic radiosurgery for the treatment of chordomas and chondrosarcomas. Acta Neurochir (Wien). 2021;163(4):10031011.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Hasegawa H, Vakharia K, Graffeo CS, et al. Long-term outcomes of grade I/II skull base chondrosarcoma: an insight into the role of surgery and upfront radiotherapy. J Neurooncol. 2021;153(2):273281.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Kano H, Sheehan J, Sneed PK, et al. Skull base chondrosarcoma radiosurgery: report of the North American Gamma Knife Consortium. J Neurosurg. 2015;123(5):12681275.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Koga T, Shin M, Saito N. Treatment with high marginal dose is mandatory to achieve long-term control of skull base chordomas and chondrosarcomas by means of stereotactic radiosurgery. J Neurooncol. 2010;98(2):233238.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Krishnan S, Foote RL, Brown PD, Pollock BE, Link MJ, Garces YI. Radiosurgery for cranial base chordomas and chondrosarcomas. Neurosurgery. 2005;56(4):777784.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Hasegawa T, Ishii D, Kida Y, Yoshimoto M, Koike J, Iizuka H. Gamma Knife surgery for skull base chordomas and chondrosarcomas. J Neurosurg. 2007;107(4):752757.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Iyer A, Kano H, Kondziolka D, et al. Stereotactic radiosurgery for intracranial chondrosarcoma. J Neurooncol. 2012;108(3):535542.

  • 33

    Rosenberg AE, Nielsen GP, Keel SB, et al. Chondrosarcoma of the base of the skull: a clinicopathologic study of 200 cases with emphasis on its distinction from chordoma. Am J Surg Pathol. 1999;23(11):13701378.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Amichetti M, Amelio D, Cianchetti M, Enrici RM, Minniti G. A systematic review of proton therapy in the treatment of chondrosarcoma of the skull base. Neurosurg Rev. 2010;33(2):155165.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Lu VM, O’Connor KP, Mahajan A, Carlson ML, Van Gompel JJ. Carbon ion radiotherapy for skull base chordomas and chondrosarcomas: a systematic review and meta-analysis of local control, survival, and toxicity outcomes. J Neurooncol. 2020;147(3):503513.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Uhl M, Mattke M, Welzel T, et al. High control rate in patients with chondrosarcoma of the skull base after carbon ion therapy: first report of long-term results. Cancer. 2014;120(10):15791585.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Simon F, Feuvret L, Bresson D, et al. Surgery and protontherapy in Grade I and II skull base chondrosarcoma: a comparative retrospective study. PLoS One. 2018;13(12):e0208786.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Shin M, Kondo K, Hanakita S, et al. Endoscopic transsphenoidal anterior petrosal approach for locally aggressive tumors involving the internal auditory canal, jugular fossa, and cavernous sinus. J Neurosurg. 2017;126(1):212221.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Hasegawa H, Shin M, Kondo K, et al. Role of endoscopic transnasal surgery for skull base chondrosarcoma: a retrospective analysis of 19 cases at a single institution. J Neurosurg. 2018;128(5):14381447.

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 989 989 33
Full Text Views 215 215 9
PDF Downloads 265 265 19
EPUB Downloads 0 0 0