Salvage Therapy for Local Progression following Definitive Therapy for Skull Base Chordomas: Is There a Role of Stereotactic Radiosurgery?

Abstract

Objective The objective of this study was to identify factors associated with improved tumor control at individual sites of recurrence and to define the role of stereotactic radiosurgery (SRS) in the management of local or distant progression following prior radiotherapy.

Study Design Clinical data of patients with recurrent skull base chordoma following prior radiotherapy were retrospectively reviewed.

Setting and Participants This is a single-center retrospective study including 16 patients from the University of Texas MD Anderson Cancer Center Houston, Texas, United States.

Main Outcome Measures Each site of recurrence was considered independently, and the primary outcome was freedom from treatment site progression (FFTSP).

Results There were 40 episodes of either local or distant progression treated in 16 patients with skull base chordoma. Tumor recurrence was classified as either local, distant, or both local and distant involving the skull base, spinal column, or leptomeninges. Patients were treated with repeat surgical resection (n = 16), SRS (n = 21), or chemotherapy (n = 25). In multivariate analysis, SRS was the only treatment modality associated with improved FFTSP (p = 0.006). For tumors treated with SRS, there was no evidence of tumor progression or adverse radiation events. Other factors associated with worse FFTSP included the number of progressive episodes (>3), tumor histology, and leptomeningeal disease.

Conclusions For local recurrence following prior radiotherapy, SRS was associated with improved FFTSP. SRS may represent an effective palliative treatment offering durable tumor control at the treated site without significant treatment-related morbidity.

Keywords

chordoma - clivus - skull base - radiation - stereotactic radiosurgery

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

• References

• 1 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 (02) e71-e83
• 2 Raza SM, Bell D, Freeman JL, Grosshans DR, Fuller GN, DeMonte F. Multimodality management of recurrent skull base chordomas: factors impacting tumor control and disease specific survival. Operative Neurosurgery. 2018; 15 (02) 131-143
• 3 Koutourousiou M, Gardner PA, Tormenti MJ. , et al. Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve. Neurosurgery 2012; 71 (03) 614-624 , discussion 624–625
• 4 Sen C, Triana AI, Berglind N, Godbold J, Shrivastava RK. Clival chordomas: clinical management, results, and complications in 71 patients. J Neurosurg 2010; 113 (05) 1059-1071
• 5 Wang L, Tian K, Wang K. , et al. Factors for tumor progression in patients with skull base chordoma. Cancer Med 2016; 5 (09) 2368-2377
• 6 Wu Z, Zhang J, Zhang L. , et al. Prognostic factors for long-term outcome of patients with surgical resection of skull base chordomas-106 cases review in one institution. Neurosurg Rev 2010; 33 (04) 451-456
• 7 Ho JC, Phan J. Reirradiation of skull base tumors with advanced highly conformal techniques. Curr Oncol Rep 2017; 19 (12) 82
• 8 Phan J, Sio TT, Nguyen TP. , et al. Reirradiation of head and neck cancers with proton therapy: outcomes and analyses. Int J Radiat Oncol Biol Phys 2016; 96 (01) 30-41
• 9 Takiar V, Garden AS, Ma D. , et al. Reirradiation of head and neck cancers with intensity modulated radiation therapy: outcomes and analyses. Int J Radiat Oncol Biol Phys 2016; 95 (04) 1117-1131
• 10 Chang SD, Martin DP, Lee E, Adler Jr JR. Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for residual or recurrent cranial base and cervical chordomas. Neurosurg Focus 2001; 10 (03) E5
• 11 Förander P, Bartek Jr J, Fagerlund M. , et al. Multidisciplinary management of clival chordomas; long-term clinical outcome in a single-institution consecutive series. Acta Neurochir (Wien) 2017; 159 (10) 1857-1868
• 12 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 (04) 752-757
• 13 Ito E, Saito K, Okada T, Nagatani T, Nagasaka T. Long-term control of clival chordoma with initial aggressive surgical resection and gamma knife radiosurgery for recurrence. Acta Neurochir (Wien) 2010; 152 (01) 57-67 , discussion 67
• 14 Kano H, Iqbal FO, Sheehan J. , et al. Stereotactic radiosurgery for chordoma: a report from the North American Gamma Knife Consortium. Neurosurgery 2011; 68 (02) 379-389
• 15 Martin JJ, Niranjan A, Kondziolka D, Flickinger JC, Lozanne KA, Lunsford LD. Radiosurgery for chordomas and chondrosarcomas of the skull base. J Neurosurg 2007; 107 (04) 758-764