Treatment of Chordomas and Chondrosarcomas With CyberKnife Robotic Hypofractionated Radiosurgery: A Single Institution Experience

Morena Sallabanda, Rafael Garcia, Luis Lorenzana, Iciar Santaolalla, Javier Abarca, Kita Sallabanda, Morena Sallabanda, Rafael Garcia, Luis Lorenzana, Iciar Santaolalla, Javier Abarca, Kita Sallabanda

Abstract

Introduction The aim of this study is to determine the efficacy and safety of CyberKnife® (Accuray, Inc., Sunnyvale, CA) hypofractionated radiosurgery (HfRS) in the treatment of chordomas and chondrosarcomas. Methods A total of 24 patients retrospectively identified with chordomas (19 patients) or chondrosarcomas (five patients) were treated between 2012 and 2019 with HfRS as monotherapy or an adjuvant, rescue, or combination therapy. Tumors were located in the skull base (75%) and vertebral spine (25%). Of these, 19 patients underwent previous partial resection and four patients received previous conventional external beam radiation therapy (EBRT) (60-74 Gy). Exclusive or rescue HfRS (20 patients) was administered in five fractions with a median dose of 37.5 Gy (30-40 Gy). Combined tomotherapy-EBRT treatment (median dose: 54 Gy) and HfRS (16.5-30 Gy in 3-12 fractions) were performed in four patients with bulky chordomas. Results The median follow-up from HfRS was 28 months. During clinical follow-up, no deaths were registered with overall survival (OS) of 100% and the actuarial local recurrence-free survival (LRFS) was 93% at one year, 85% at three years, and 68% at five years. Acute toxicity related to HfRS was present in a single patient. Conclusions It is seen that HfRS is effective and safe for chordomas and chondrosarcomas, with rates of LRFS comparable to other radiation modalities.

Keywords: chondrosarcoma; chordoma; cyberknife; hypofractionation; radiosurgery.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Sallabanda et al.

Figures

Figure 1. CyberKnife MultiPlan® (Accuray, Inc., Sunnyvale,…
Figure 1. CyberKnife MultiPlan® (Accuray, Inc., Sunnyvale, CA) planning of a clival chordoma treatment with 37.5 Gy in five fractions.
Figure 2. Global actuarial LRFS in chordomas…
Figure 2. Global actuarial LRFS in chordomas and chondrosarcomas from HfRS and comparison of actuarial LRFS curves between chordomas and chondrosarcomas
LRFS: Local recurrence-free survival; HfRS: Hypofractionated radiosurgery
Figure 3. Univariate analysis comparing actuarial LRFS…
Figure 3. Univariate analysis comparing actuarial LRFS curves between previous or combined vs. absence of EBRT in chordoma and chondrosarcoma patients
LRFS: Local relapse-free survival; EBRT: External beam radiation therapy; HfRS: hypofractionated radiosurgery

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Source: PubMed

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