Investigation of ectopic recurrent skull base and cervical chordomas: The Institut Curie's proton therapy center experience.
Cervical and skull base chordomas may relapse locally, marginally, or in ectopic sites (ie, surgical pathway, lymph nodes, prevertebral space, subdural space, or distant organs).



Among 371 patients treated between 1995 and 2010, we matched the initial dosimetry with the 3D imaging of recurrence and selected the patients with isolated ectopic recurrence.



During our follow-up, we identified 13 patients who developed ectopic relapses (n = 18) in the form of lung metastasis (n = 2), axial dissemination (n = 6), nodal recurrence (n = 2), subcutaneous metastasis (n = 3), and/or seeding along the surgical pathway (n = 5). Despite treatment of these 13 patients with radiation, surgical interventions, and/or chemotherapy, we could only salvage 5 patients with recurrence in surgical pathway, whereas the remaining 8 patients succumbed to a poor prognosis.



Our study emphasizes an urgent need for prediction and early diagnosis of ectopic relapses in patients with cervical and skull base chordoma to improve accuracy of their aggressive treatments. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1238-E1246, 2016.
Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France.
Guillaume
0000-0002-8114-5900
G
Vogin
Department of Radiation Oncology, Institut Curie, Paris, France.|Protontherapy Center, Institut Curie, Orsay, France.
Valentin
V
Calugaru
Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.|Protontherapy Center, Institut Curie, Orsay, France.
Stéphanie
S
Bolle
Department of Neurosurgery, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Paris, France.
Bernard
B
George
Department of Radiology, Institut de Cancérologie de Lorraine, Nancy, France.
Guillaume
G
Oldrini
Department of Radiation Oncology, Centre François Baclesse, Caen, France.|Protontherapy Center, Institut Curie, Orsay, France.
Jean-Louis
JL
Habrand
Department of Radiation Oncology, Institut Curie, Paris, France.|Protontherapy Center, Institut Curie, Orsay, France.
Hamid
H
Mammar
Department of Radiation Oncology, Institut Curie, Paris, France.|Protontherapy Center, Institut Curie, Orsay, France.
Rémi
R
Dendale
Department of Biostatistics, Institut de Cancérologie de Lorraine, Nancy, France.
Julia
J
Salleron
Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France.
Georges
G
Noël
Protontherapy Center, Institut Curie, Orsay, France.|Department of Radiation Oncology, Hôpital La Pitié Salpétrière, Assistance Publique - Hôpitaux de Paris, Paris, France.
Loïc
L
Feuvret
D000293:Adolescent; D000328:Adult; D000368:Aged; D002817:Chordoma / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D061766:Proton Therapy; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D055815:Young Adult
cervical and skull base chordomas; metastasis; neuraxial recurrence; nodal recurrence; proton therapy; surgical pathway recurrence