The role of Gamma Knife radiosurgery in the management of skull base chordoma

Abstract

ObjectiveChordoma is a slow-growing and locally aggressive cancer, which arises from the remnants of the primitive notochord. The first line treatment for the skull base chordoma is neurosurgery. Gamma Knife radiosurgery (GKS) is often be chosen especially in the setting of residual or recurrent chordomas. The purpose of this study is to evaluate the prognosis of patients with skull base chordoma who underwent GKS.MethodsThe present study was a retrospective analysis of 53 patients with skull base chordomas who underwent GKS. Univariate Cox and Kaplan-Meier survival analysis were performed to analyze the relationship between the tumor control time and the clinical characteristics.ResultsThe 1-, 2-, 3-, and 5-year progression free survival (PFS) rates were 87, 71, 51, and 18%, respectively. After performing the univariate analysis, the clinical characteristics were not found to be significantly associated with the time of PFS; however, surgical history, peripheral dose, and tumor volume did have tendencies to predict the prognosis.ConclusionGKS provided a safe and relatively effective treatment for residual or recurrent chordomas after surgical resection. A higher tumor control rate depends on two approaches, an appropriate dose of radiation for the tumor and the accurate identification of the tumor margins.

Outcomes of the Endoscopic Endonasal Approach for the Treatment of Clival Chordomas: A Single-Center Experience

“…Noël et al and Deraniyagala et al reported 2-year local control rates of 86.3% and 86%, respectively; all with patients receiving adjuvant proton therapy. Wang et al also noted a 2-year progression-free survival rate of 71% with the use of Gamma Knife radiosurgery (10). Of the patients in our series, 35.3% did not receive radiation therapy, which would explain the low PFS relative to the others; 64.7% received postoperative RT; and 72% received CyberKnife RT.…”

“…16 Wang et al also noted a 2-year PFS rate of 71% with the use of Gamma Knife radiosurgery. 10 Of the patients in our series, 35.3% did not receive RT, which would explain the low PFS relative to the others; 64.7% received postoperative RT; and 72% received CK RT. Notably, we opted for CK radiosurgery as an alternative to proton therapy, given the unavailability of proton therapy facilities in our region during the study period.…”

“…Notably, we opted for CK radiosurgery as an alternative to proton therapy, given the unavailability of proton therapy facilities in our region during the study period. This choice was influenced by previous studies 4, [10][11][12] that have reported comparable results between Gamma Knife radiosurgery and proton therapy. Wang et al reported 3-year overall survival of 81% and PFS of 51%.…”

“…12 Wang et al presented clinical data from 13 studies, revealing that the 5-year local control rate of chordoma following Gamma Knife treatment ranged from 21.4 to 76%, while the 5-year survival rate varied between 67 and 100%. 10 The mean time until RT received was 19.67 weeks, as the delay of the RT was for logistical conscience. Age, preoperative hydrocephalus, tumor CC, and upper clivus involvement were significantly associated with tumor progression.…”

“…studies (4) (11) (10) (12) that have reported comparable results between Gamma Knife radiosurgery and proton therapy. Wang et al reported 3-year overall survival of 81% and PFS of 51% (4).…”