J Neurol Surg B 2020; 81(01): 097-106
DOI: 10.1055/s-0039-1679897
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Salvage Therapy for Local Progression following Definitive Therapy for Skull Base Chordomas: Is There a Role of Stereotactic Radiosurgery?

Linton T. Evans
1  Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Franco DeMonte
1  Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
David R. Grosshans
2  Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Amol J. Ghia
2  Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Ahmed Habib
1  Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Shaan M. Raza
1  Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
› Author Affiliations
Funding No funding was received for this research.
Further Information

Publication History

10 October 2018

12 January 2019

Publication Date:
21 February 2019 (online)

Abstract

Objective The objective of this study was to identify factors associated with improved tumor control at individual sites of recurrence and to define the role of stereotactic radiosurgery (SRS) in the management of local or distant progression following prior radiotherapy.

Study Design Clinical data of patients with recurrent skull base chordoma following prior radiotherapy were retrospectively reviewed.

Setting and Participants This is a single-center retrospective study including 16 patients from the University of Texas MD Anderson Cancer Center Houston, Texas, United States.

Main Outcome Measures Each site of recurrence was considered independently, and the primary outcome was freedom from treatment site progression (FFTSP).

Results There were 40 episodes of either local or distant progression treated in 16 patients with skull base chordoma. Tumor recurrence was classified as either local, distant, or both local and distant involving the skull base, spinal column, or leptomeninges. Patients were treated with repeat surgical resection (n = 16), SRS (n = 21), or chemotherapy (n = 25). In multivariate analysis, SRS was the only treatment modality associated with improved FFTSP (p = 0.006). For tumors treated with SRS, there was no evidence of tumor progression or adverse radiation events. Other factors associated with worse FFTSP included the number of progressive episodes (>3), tumor histology, and leptomeningeal disease.

Conclusions For local recurrence following prior radiotherapy, SRS was associated with improved FFTSP. SRS may represent an effective palliative treatment offering durable tumor control at the treated site without significant treatment-related morbidity.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.