High-dose proton-based radiation therapy in the management of spine chordomas: Outcomes and clinicopathological prognostic factors

Ronny L. Rotondo, Wendy Folkert, Norbert J. Liebsch, Yen Lin E Chen, Frank X. Pedlow, Joseph H. Schwab, Andrew Rosenberg, G. Petur Nielsen, Jackie Szymonifka, Al E. Ferreira, Francis J. Hornicek, Thomas F. DeLaney

Research output: Contribution to journalArticle

65 Scopus citations

Abstract

Obj ect Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. Methods?The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. Results?Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for R0/R1 margins and the absence of intralesional procedures. Con clusions?High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.

Original languageEnglish (US)
Pages (from-to)788-797
Number of pages10
JournalJournal of Neurosurgery: Spine
Volume23
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Keywords

  • Chordoma
  • Oncology
  • Radiation therapy
  • Sacrum
  • Spine
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology
  • Medicine(all)

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  • Cite this

    Rotondo, R. L., Folkert, W., Liebsch, N. J., Chen, Y. L. E., Pedlow, F. X., Schwab, J. H., Rosenberg, A., Nielsen, G. P., Szymonifka, J., Ferreira, A. E., Hornicek, F. J., & DeLaney, T. F. (2015). High-dose proton-based radiation therapy in the management of spine chordomas: Outcomes and clinicopathological prognostic factors. Journal of Neurosurgery: Spine, 23(6), 788-797. https://doi.org/10.3171/2015.3.SPINE14716