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

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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.

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Data availability

De-identified data will be available upon request on a case-by-case basis to researchers who provide a methodologically sound proposal. Requests should be made to the corresponding author and will then be evaluated by the participating study institutions.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil

    Andre Tsin Chih Chen, Carlos Bo Chur Hong & Alexandre Ruggieri Serante

  2. Department of Spine Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil

    Douglas Kenji Narazaki, Brian Guilherme Monteiro Marta Coimbra & William Gemio Jacobsen Teixeira

  3. Department of Radiology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil

    Virginio Rubin

  4. Department of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil

    Ulysses Ribeiro Junior

  5. Department of Pathology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil

    Luiz Guilherme Cernaglia Aureliano de Lima

  6. Department of Spine Surgery of Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil

    Alexandre Fogaça Cristante

Authors
  1. Andre Tsin Chih Chen
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  2. Carlos Bo Chur Hong
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  10. William Gemio Jacobsen Teixeira
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Contributions

Study conception: ATCC; WJGT. Data Collection: ATCC; CBCH; ARS; VR; LGCAL; BGMMC; WJGT. Statistical Analysis: ATCC. Initial Draft: ATCC. Interpretation of results and approval of final manuscript: all authors.

Corresponding author

Correspondence to Andre Tsin Chih Chen.

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The authors declare no potential conflicts of interest.

Ethical approval

This study was approved by the Institutional Review Board, Local Ethics Committee and was conducted in accordance with the Ethical Principles of the Declaration of Helsinki.

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Chen, A.T.C., Hong, C.B.C., Narazaki, D.K. et al. High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes. J Neurooncol 158, 23–31 (2022). https://doi.org/10.1007/s11060-022-04003-w

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  • DOI: https://doi.org/10.1007/s11060-022-04003-w

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