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

Jun Won Kim, Chang Ok Suh, Chang Ki Hong, Eui Hyun Kim, Ik Jae Lee, Jaeho Cho, Kyu Sung Lee

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1825-1834
Number of pages10
JournalActa Neurochirurgica
Volume159
Issue number10
DOIs
Publication statusPublished - 2017 Oct 1

Fingerprint

Chordoma
Intensity-Modulated Radiotherapy
Adjuvant Radiotherapy
Skull Base
Posterior Cranial Fossa
Neurologic Manifestations
Disease-Free Survival
Neoplasms
Appointments and Schedules
Survival Rate
Morbidity
Recurrence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Kim, Jun Won ; Suh, Chang Ok ; Hong, Chang Ki ; Kim, Eui Hyun ; Lee, Ik Jae ; Cho, Jaeho ; Lee, Kyu Sung. / Maximum surgical resection and adjuvant intensity-modulated radiotherapy with simultaneous integrated boost for skull base chordoma. In: Acta Neurochirurgica. 2017 ; Vol. 159, No. 10. pp. 1825-1834.
@article{543956070f1a4f339aabd72cd83dfa4b,
title = "Maximum surgical resection and adjuvant intensity-modulated radiotherapy with simultaneous integrated boost for skull base chordoma",
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.",
author = "Kim, {Jun Won} and Suh, {Chang Ok} and Hong, {Chang Ki} and Kim, {Eui Hyun} and Lee, {Ik Jae} and Jaeho Cho and Lee, {Kyu Sung}",
year = "2017",
month = "10",
day = "1",
doi = "10.1007/s00701-016-2909-y",
language = "English",
volume = "159",
pages = "1825--1834",
journal = "Acta Neurochirurgica",
issn = "0001-6268",
publisher = "Springer Wien",
number = "10",

}

Maximum surgical resection and adjuvant intensity-modulated radiotherapy with simultaneous integrated boost for skull base chordoma. / Kim, Jun Won; Suh, Chang Ok; Hong, Chang Ki; Kim, Eui Hyun; Lee, Ik Jae; Cho, Jaeho; Lee, Kyu Sung.

In: Acta Neurochirurgica, Vol. 159, No. 10, 01.10.2017, p. 1825-1834.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Maximum surgical resection and adjuvant intensity-modulated radiotherapy with simultaneous integrated boost for skull base chordoma

AU - Kim, Jun Won

AU - Suh, Chang Ok

AU - Hong, Chang Ki

AU - Kim, Eui Hyun

AU - Lee, Ik Jae

AU - Cho, Jaeho

AU - Lee, Kyu Sung

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84981156770&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84981156770&partnerID=8YFLogxK

U2 - 10.1007/s00701-016-2909-y

DO - 10.1007/s00701-016-2909-y

M3 - Article

C2 - 27502775

AN - SCOPUS:84981156770

VL - 159

SP - 1825

EP - 1834

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

SN - 0001-6268

IS - 10

ER -