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. 2022 May;158(1):23-31.
doi: 10.1007/s11060-022-04003-w. Epub 2022 Apr 22.

High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes

Andre Tsin Chih Chen  1 , Carlos Bo Chur Hong  2 , Douglas Kenji Narazaki  3 , Virginio Rubin  4 , Alexandre Ruggieri Serante  2 , Ulysses Ribeiro Junior  5 , Luiz Guilherme Cernaglia Aureliano de Lima  6 , Brian Guilherme Monteiro Marta Coimbra  3 , Alexandre Fogaça Cristante  7 , William Gemio Jacobsen Teixeira  3
Affiliations

High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes

Andre Tsin Chih Chen et al. J Neurooncol. 2022 May.

Abstract

Purpose: To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base.

Methods: Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure.

Results: A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63).

Conclusion: Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.

Keywords: Chordoma; Intensity modulated radiation therapy (IMRT); Photon.

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