• Stylianos Pikis, Georgios Mantziaris, Selcuk Peker, Yavuz Samanci, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, El-ShehabyAmr M NAMN3Gamma Knife Center Cairo, Nasser Institute, Cairo.5Ain Shams University, Cairo., Khaled Abdelkarim, EldinReem M EmadRME3Gamma Knife Center Cairo, Nasser Institute, Cairo.6Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt., Darrah Sheehan, Kimball Sheehan, Roman Liscak, Tomas Chytka, Manjul Tripathi, Renu Madan, Herwin Speckter, Wenceslao Hernández, Gene H Barnett, Yusuke S Hori, Nisha Dabhi, Salman Aldakhil, David Mathieu, Douglas Kondziolka, Kenneth Bernstein, Zhishuo Wei, Ajay Niranjan, Charles R Kersh, L Dade Lunsford, and Jason P Sheehan.
• 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
• J. Neurosurg. 2022 Oct 1; 137 (4): 977984977-984.

ObjectiveThe object of this study was to evaluate the safety, efficacy, and long-term outcomes of stereotactic radiosurgery (SRS) in the management of intracranial chordomas.MethodsThis retrospective multicenter study involved consecutive patients managed with single-session SRS for an intracranial chordoma at 10 participating centers. Radiological and neurological outcomes were assessed after SRS, and predictive factors were evaluated via statistical methodology.ResultsA total of 93 patients (56 males [60.2%], mean age 44.8 years [SD 16.6]) underwent single-session SRS for intracranial chordoma. SRS was utilized as adjuvant treatment in 77 (82.8%) cases, at recurrence in 13 (14.0%) cases, and as primary treatment in 3 (3.2%) cases. The mean tumor volume was 8 cm3 (SD 7.3), and the mean prescription volume was 9.1 cm3 (SD 8.7). The mean margin and maximum radiosurgical doses utilized were 17 Gy (SD 3.6) and 34.2 Gy (SD 6.4), respectively. On multivariate analysis, treatment failure due to tumor progression (p = 0.001) was associated with an increased risk for post-SRS neurological deterioration, and a maximum dose > 29 Gy (p = 0.006) was associated with a decreased risk. A maximum dose > 29 Gy was also associated with improved local tumor control (p = 0.02), whereas the presence of neurological deficits prior to SRS (p = 0.04) and an age > 65 years at SRS (p = 0.03) were associated with worse local tumor control. The 5- and 10-year tumor progression-free survival rates were 54.7% and 34.7%, respectively. An age > 65 years at SRS (p = 0.01) was associated with decreased overall survival. The 5- and 10-year overall survival rates were 83% and 70%, respectively.ConclusionsSRS appears to be a safe and relatively effective adjuvant management option for intracranial chordomas. The best outcomes were obtained in younger patients without significant neurological deficits. Further well-designed studies are necessary to define the best timing for the use of SRS in the multidisciplinary management of intracranial chordomas.

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