Document Detail


Treatment of chordomas with CyberKnife: georgetown university experience and treatment recommendations.
MedLine Citation:
PMID:  19165073     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the efficacy and safety of chordoma treatment with CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (CK/SRS). METHODS: Eighteen patients with chordoma were treated with CK/SRS as a primary adjuvant (17 patients) or the only treatment (1 patient). The series included 24 lesions (28 treatments). The median age of the patients was 60 years (range, 24-85 years). Forty-four percent of the tumors were located in the mobile spine, 39% inside the cranium, and 17% in the sacral region. The male-to-female ratio was 1:1. The mean tumor volume was 128.0 mL (range, 12.0-457.3 mL), and the median dose of 35 Gy (range, 24.0-40.0 Gy) was delivered in 5 sessions. The median follow-up period was 46 months (range, 7-65 months). RESULTS: There were 3 significant complications in patients with previous irradiation, including infection in the surgical/radiation site (2 patients) and decreased vision (1 patient). Improvement in pain and quality of life did not reach statistical significance (alpha = 0.05). Seven patients experienced recurrence at a median of 10 months (range, 5-38 months), and 4 patients with disseminated disease died 7 to 48 months after therapy. Two patients had a partial response, whereas 9 others had stable disease. The local control rate at 65 months was 59.1%, with an overall survival of 74.3% and disease-specific survival of 88.9%. We estimated an alpha/beta ratio of 2.45 for chordomas, which supports hypofractionation. CONCLUSION: The CK/SRS safety and efficacy profile compares favorably with those of other treatment delivery systems. CK/SRS appears to reduce tumor volume, given an adequate dose. The authors recommend treatment with 40 Gy in 5 sessions to the clinical treatment volume, which includes the gross tumor volume and at least a 1-cm margin.
Authors:
Fraser C Henderson; Kyle McCool; Juliet Seigle; Walter Jean; William Harter; Gregory J Gagnon
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  64     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-23     Completed Date:  2009-03-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  A44-53     Citation Subset:  IM    
Affiliation:
Department of Radiology, Georgetown University, Washington, District of Columbia 20007, USA. henderson@fraserhendersonmd.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Central Nervous System Neoplasms / mortality,  surgery*
Chordoma / mortality,  surgery*
Dose Fractionation
Female
Humans
Kaplan-Meiers Estimate
Magnetic Resonance Imaging
Male
Middle Aged
Pain / surgery
Postoperative Complications
Quality of Life
Radiosurgery* / adverse effects,  instrumentation,  methods
Treatment Outcome
Universities

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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