High Dose Radiosurgery Targeting the Primary Tumor Sites Contributes to Survival in Patients With Skull Base Chordoma

Yuki Shinya, Hirotaka Hasegawa, Masahiro Shin, Mariko Kawashima, Tomoyuki Koga, Shunya Hanakita, Atsuto Katano, Takehiro Sugiyama, Yuki Nozawa, Nobuhito Saito

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2 Scopus citations


Purpose: Skull base chordoma (SBC) is a rare, aggressive bone tumor and a challenging therapeutic target. The efficacy of stereotactic radiosurgery (SRS) for SBC remains unclear. We aimed to elucidate therapeutic factors for favorable outcomes and establish a novel therapeutic approach for SBC. Methods and Materials: This single-center retrospective study examined 47 SBCs treated with SRS. Treatment factors affecting local control rates (LCRs), remote control rates (RCRs), and overall survival (OS) were evaluated. Initially, we applied “localized-field SRS,” wherein the irradiated volume accurately included recurrent/residual tumors on the radiographic images. Since 2015, we systematically applied “extended-field SRS,” wherein the irradiated volume included the tumor location on the radiographic images and the preoperative tumor location with 2-mm margins. Results: Tumor progression was observed in 23 SBCs (49%) after SRS. Higher marginal doses ≥20 Gy resulted in a higher LCR than lower-dose treatments (92% at 2 years and 73% at 5 years vs 43% at 2 years and 21% at 3 years, P = .001). Twenty-four patients underwent extended-field SRS, and 23 underwent localized-field SRS. While the LCRs were not significantly different, extended-field SRS improved RCRs (extended-field SRS: 100% vs localized-field SRS: 46% at 5 years; P = .001) without radiation-induced adverse events. Multivariate analysis demonstrated that extended-field SRS was associated with better RCRs (P = .001) and OS (P = .001). Conclusions: Extended-field SRS achieved LCRs comparable to previous studies and excellent OS without increasing the risk of radiation-induced adverse events.

Original languageEnglish (US)
Pages (from-to)582-587
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number3
StatePublished - Jul 1 2022
Externally publishedYes

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