title: Adjuvant Stereotactic Radiosurgery and Radiation Therapy for the Treatment of Intracranial Chordomas.
abstract: Objective Chordomas are locally aggressive, highly recurrent tumors requiring adjuvant radiotherapy following resection for successful management. We retrospectively reviewed patients treated for intracranial chordomas with adjuvant stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT). Methods A total of 57 patients underwent 83 treatments at the UCLA Medical Center between February 1990 and August 2011. Mean follow-up was 57.8 months. Mean tumor diameter was 3.36 cm. Overall, 8 and 34 patients received adjuvant SRS and SRT, and the mean maximal dose of radiation therapy was 1783.3 cGy and 6339 cGy, respectively. Results Overall rate of recurrence was 51.8%, and 1- and 5-year progression-free survival (PFS) was 88.2% and 35.2%, respectively. Gross total resection was achieved in 30.9% of patients. Adjuvant radiotherapy improved outcomes following subtotal resection (5-year PFS 62.5% versus 20.1%; p = 0.036). SRS and SRT produced comparable rates of tumor control (p = 0.28). Higher dose SRT (> 6,000 cGy) (p = 0.013) and younger age (< 45 years) (p = 0.03) was associated with improved rates of tumor control. Conclusion Adjuvant radiotherapy is critical following subtotal resection of intracranial chordomas. Adjuvant SRT and SRS were safe and improved PFS following subtotal resection. Higher total doses of SRT and younger patient age were associated with improved rates of tumor control.
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Winward
authors.initials: W
authors.lastname: Choy
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Sergei
authors.initials: S
authors.lastname: Terterov
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Nolan
authors.initials: N
authors.lastname: Ung
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Tania
authors.initials: T
authors.lastname: Kaprealian
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Andy
authors.initials: A
authors.lastname: Trang
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Antonio
authors.initials: A
authors.lastname: DeSalles
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Lawrance K
authors.initials: LK
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Neil
authors.initials: N
authors.lastname: Martin
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Selch
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Marvin
authors.initials: M
authors.lastname: Bergsneider
authors.affiliation: Department of Pathology, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: William
authors.initials: W
authors.lastname: Yong
authors.affiliation: Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, United States.
authors.forename: Isaac
authors.initials: I
authors.lastname: Yang
keywords: chordoma; prognostic factors; radiation therapy; radiosurgery; surgery