title: Image-guided, intensity-modulated radiation therapy (IG-IMRT) for skull base chordoma and chondrosarcoma: preliminary outcomes.
abstract: BACKGROUND
  We report our preliminary outcomes following high-dose image-guided intensity modulated radiotherapy (IG-IMRT) for skull base chordoma and chondrosarcoma.
  
  
  METHODS
  Forty-two consecutive IG-IMRT patients, with either skull base chordoma (n = 24) or chondrosarcoma (n = 18) treated between August 2001 and December 2012 were reviewed. The median follow-up was 36 months (range, 3-90 mo) in the chordoma cohort, and 67 months (range, 15-125) in the chondrosarcoma cohort. Initial surgery included biopsy (7% of patients), subtotal resection (57% of patients), and gross total resection (36% of patients). The median IG-IMRT total doses in the chondrosarcoma and chordoma cohorts were 70 Gy and 76 Gy, respectively, delivered with 2 Gy/fraction.
  
  
  RESULTS
  For the chordoma and chondrosarcoma cohorts, the 5-year overall survival and local control rates were 85.6% and 65.3%, and 87.8% and 88.1%, respectively. In total, 10 patients progressed locally: 8 were chordoma patients and 2 chondrosarcoma patients. Both chondrosarcoma failures were in higher-grade tumors (grades 2 and 3). None of the 8 patients with grade 1 chondrosarcoma failed, with a median follow-up of 77 months (range, 34-125). There were 8 radiation-induced late effects-the most significant was a radiation-induced secondary malignancy occurring 6.7 years following IG-IMRT. Gross total resection and age were predictors of local control in the chordoma and chondrosarcoma patients, respectively.
  
  
  CONCLUSIONS
  We report favorable survival, local control and adverse event rates following high dose IG-IMRT. Further follow-up is needed to confirm long-term efficacy.
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Laurence
authors.initials: L
authors.lastname: Masson-Cote
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bahl
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Eugene
authors.initials: E
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Barbara-Ann
authors.initials: BA
authors.lastname: Millar
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Caroline
authors.initials: C
authors.lastname: Chung
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Charles
authors.initials: C
authors.lastname: Catton
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Ralph
authors.initials: R
authors.lastname: Gilbert
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Gelareh
authors.initials: G
authors.lastname: Zadeh
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Michael
authors.initials: M
authors.lastname: Cusimano
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Fred
authors.initials: F
authors.lastname: Gentili
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S.); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (A.S., L.M.-C., G.B., B.-A.M., C.C., C.C., B.O., N.J.L.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.W.C.); Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (E.G.A); Department of Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada (E.Y.); Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada (J.C.I., R.G.); Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (G.Z., F.G.); Department of Neurosurgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada (M.C.).
authors.forename: Normand J
authors.initials: NJ
authors.lastname: Laperriere
mesh_terms: D000328:Adult; D000368:Aged; D002813:Chondrosarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002817:Chordoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061089:Radiotherapy, Image-Guided; D012888:Skull Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: chondrosarcoma; chordoma; image-guided intensity modulated radiotherapy; photon radiation