Hypofractionated Radiosurgery for Skull Base, Spinal, and Sacral Chordomas: A Systematic Review and Meta-analysis

Introduction: Chordomas’ critical locations within skull base, spine, and sacrum limit the maximal dose that can be administered to ensure tumor regression. To mitigate radiation side-effects, fractionation protocols ensure the delivery of equivalent or higher total radiation in manageable fractions, while maintaining comparable side-effect profiles. Hypofractionated stereotactic radiosurgery (HF-SRS) is a fractionation strategy that administers higher doses per fraction (>2 Gy) necessitating fewer fractions overall, addressing potentially higher obliteration rates, low side-effects and ensuring patient compliance. We performed a systematic review and meta-analysis to evaluate the outcomes of HF-SRS utilization in the treatment of skull base, spinal and sacral chordomas and chondrosarcomas.

Methods: PubMed and Embase were queried for literature on “hypofractionated” “radiosurgery” for “chordomas.” Data on patient and chordoma characteristics, procedural details, follow-up outcomes and survival were extracted from eligible studies. Meta-analyses using random-effects models were conducted on variables reported by ≥3 studies on R version 4.3.2.

Results: We included 11 studies reporting 165 patients with a mean age of 47.69 years (43.38–52.43) (Tables 1 and 2), representing 58.04% (49.75–65.91) males. Skull base chordomas constituted 71.23% (57.61–81.86) with an additional 23.33% (15.72–33.17) detected in the mobile spine. Chondrosarcomas formed 12.49% (5.96–24.33) of all tumors. A mean dosage of 29.74 Gy (25.40–34.82) were delivered in 4.11 (3.59–4.71) fractions at 7.60 (7.18–8.04) Gy/fraction. On mean follow-up duration of 31.22 months (19.06–51.14), we observed 10.88% (5.89–19.21) radionecrosis and 11.28% (5.29–22.50) chordoma-related mortality rate. Overall survival was 92.64% (86.65–96.07), 89.91% (80.44–95.08), and 83.29% (67.24–92.37) at 1, 2, and 5 years, respectively, while progression-free survival respectively was 83.43% (74.36–89.73), 81.49% (72.50–88.03), and 72.47% (59.94–82.24).

Conclusion: HF-SRS is promising among radiosurgical strategies for chordoma treatment with a low complication rate, indicating promise for potential first-line use. Significant heterogeneity in dosing regimens warrants additional investigation and necessitates homogenous reporting with the incorporation location specific chordoma, treatment and survival information.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025