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Maximum surgical resection and adjuvant intensity-modulated radiotherapy with simultaneous integrated boost for skull base chordoma

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Local recurrence is common after surgical resection of clivus chordoma. We report the results of maximum surgical resection followed by intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB).

Methods

We reviewed 14 consecutive clivus chordoma cases undergoing postoperative IMRT-SIB using the institutional protocol between 2005 and 2013. Total and near-total resections were achieved in 11 patients (78.6 %), partial in 2 patients (14.3 %), and 1 patient (7.1 %) received RT for recurrent tumor after total resection. Gross residual or the high-risk area defined the planning target volume (PTV)1; PTV2 was the postoperative tumor bed plus a 3–5-mm margin, and PTV3 was PTV2 plus a 5–10 mm margin. A moderate hypofractionation schedule was used: doses to PTV1, PTV2 and PTV3 were 3.9 Gy, 3.15 Gy and 2.8 Gy through 15 fractions for the first two patients, and the rest received 2.5 Gy, 2.2 Gy and 1.8 Gy through 25 fractions. The biologically equivalent dose in 2-Gy fractions (EQD2) was 65–68 Gy for PTV1, 52–56 Gy for PTV2, and 44.3–44.8 Gy for PTV3.

Results

Median follow-up was 41 months. Eight patients were free of disease for median 42.5 months (range 23–91 months), four patients had stable disease for median 60.5 months (range 39–113 months), and 1 patient showed partial response for 38 months after RT. Local progression was seen in one patient who received EQD2 67.8 Gy after partial resection. Estimated 5-year progression-free and overall survival rates were 92.9 %. Surgery improved the neurologic deficit in six patients, and IMRT-SIB was well tolerated without lasting toxicity.

Conclusion

Our experience suggests that maximum resection and high-dose IMRT-SIB can achieve local control without significant morbidities.

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Acknowledgments

The authors report no funding sources supporting this research.

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Authors and Affiliations

  1. Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea

    Jun Won Kim & Ik Jae Lee

  2. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Chang-Ok Suh & Jaeho Cho

  3. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea

    Chang-Ki Hong & Kyu-Sung Lee

  4. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Eui Hyun Kim

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  1. Jun Won Kim
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Correspondence to Kyu-Sung Lee.

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The authors declare that they have no conflict of interest.

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

Additional information

The abstract of the current study was presented as a poster at the 54th Annual Meeting of the American Society for Radiation Oncology (ASTRO), Boston, MA, October 2012.

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Kim, J.W., Suh, CO., Hong, CK. et al. Maximum surgical resection and adjuvant intensity-modulated radiotherapy with simultaneous integrated boost for skull base chordoma. Acta Neurochir 159, 1825–1834 (2017). https://doi.org/10.1007/s00701-016-2909-y

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