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. 2017 Feb 9;28(6):1230–1242. doi: 10.1093/annonc/mdx054

Table 3.

Local control of primary and locally recurrent chordoma patients of all sites treated with surgery plus RT or definitive RT

Series (REF) Year N. pts Type of RT Dose and fractionation Mean FU (years) Oncological outcome
Skull base
 Munzenrider [63] 1999 290 Surgery+protontherapy (passive fields)+photon RT

  • 66–83 CGE

  • Protons 4 fxs/week (1.92 CGE)

  • Photons 1 fx/week (1.8 Gy)

 3.4 5-year LRFS 73% chordoma
 Noel [64] 2005 88 Surgery+protontherapy (passive fields) Median dose 67 CGE with standard fractionation 2.6 2-year LC 86%
 Ares [65] 2009 41 Surgery+protontherapy (active spot scanning) Median total dose 73.5 Gy (RBE) with standard fractionation 3.2 5-year LC—81%
 Mizoe [66] 2009 33 Surgery+carbon ions (passive fields) Dose escalation 48.0, 52.8, 57.6, and 60.8 Gy in 16 fractions 4.4

  • 5-year LC—85%

  • 10-year LC—64%
 Uhl [61] 2014 155 Surgery+carbon ions (active spot scanning)

  • 60 Gy RBE

  • 3 Gy RBE per fraction

 6

  • 5-year LC—72%

  • 10-year LC—54%
 Choy [67] 2016 57 Surgery+stereotactic radio surgery (SRS) or stereotactic radiotherapy (SRT)

  • SRS 17.8 Gy

  • SRT 63.4 Gy

  • Hypofractionated schedule

 4.8 Overall LC 48%5-year PFS 35.2%
 Bugoci [68] 2013 12 Surgery+fractionated stereotactic radiotherapy Median dose 66.6 Gy with standard fractionation 3.5 5-year PFS 37.5%
 Kano [69] 2011 71 Surgery+Gamma Knife stereotactic radiosurgery (SRS) Median margin dose 15.0 Gy (range 9–25 Gy) 5 5-year LC 66%
 Chang [70] 2001 10 (8 skull base, 2 cervical spine) Surgery+LINAC stereotactic radiosurgery Mean radiation dose 19.4 Gy 4 Gross LC 80%
 Zorlu [71] 2000 18 Surgery+3D photons RT Median 60 Gy with standard fractionation 3.6 5-year PFS 23%
 Foweraker [72] 2007 12 (10 clivus, 2 cervical spine) Surgery+photons radiotherapy 65 Gy in 39 fractions 3.2 Gross LC 92%
Sacrum and spine
 Imai [62] 2016 188 Exclusive carbon ions (passive fields) Median 67.2 GyE in 16 fractions 5.2 (median)

  • Primary tumor

  • 10-year OS 69%

  • 5-year LC 77.2%

  • Recurrent tumor

  • 10-year OS 52%
 Uhl [61] 2015 56 (41 primary tumors, 15 recurrent tumors) Carbon ions (active scanning) or photons RT and carbon ions (active scanning)±surgery (10 R0/R1 resection 11 R2 resections 20 biopsy only, 15 recurrences) Median 66 GyE 2.1

  • Primary tumor

  • 2-year OS 100%

  • 2-year LC 100%

  • Recurrent tumor

  • 2-year OS 100%

  • 2-year LC 47%
 Mima [73] 2014 23 Exclusive carbon ions or exclusive protontherapy 70.4 GyE in 16 fractionsor in 32 fractions 3.2 3-year LC—94%
 Rotondo [60] 2015 126 (71 sacrococcygeal, 40 lumbar, 16 thoracic) Surgery+protontherapy Median 72.4 Gy RBE with standard fractionation 3.5

  • Primary tumor

  • 5-year OS 81%

  • 5-year LC 68%

  • Recurrent tumor

  • 5-year OS 78%

  • 5-year LC 49%
 Holliday [74] 2015 19 Surgery+protontherapy Median 70 Gy RBE with standard fractionation 32.9 2-year LC—58%
 DeLaney [59] 2014 29 (23 primary, 6 recurrent) Surgery+protontherapy 77.4 Gy RBE with standard fractionation 7.3

  • Primary tumor

  • 5-year LC 100%

  • 8-year LC 92%

  • Recurrent tumor

  • 5-year LC 50%
 Chen [75] 2013 24 (19 sacrum, 2 cervical, 1 thoracic, and 2 lumbar spine) Exclusive protontherapy (passive fields) 77.4 Gy RBE (range 71.6–79.2 Gy RBE) with standard fractionation 4.7 5-year LPFS 79.8%
 Staab [58] 2011 40 (32 primary, 8 recurrent) (21 adjuvant RT, 19 macroscopic disease) Protontherapy spot scanning±radical surgery 72.5 Gy RBE with standard fractionation 3.6

  • 5-year OS 80%

  • 5-year LC 62%
 Dhawale [76] 2014 21 (sacrum) Surgery + (18) − (3) 3D conformal RT or IMRT Mean dose 56 Gy with conventional fractionation 5.8 Gross LC 60%
 Zabel-du Bois [57] 2010 34

  • First diagnosis: surgery+adjuvant IMRT (13) or IMRT alone (4)

  • Recurrent tumor

  • Surgery+adjuvant IMRT (11) or IMRT alone (6)

 Mean dose 66 Gy with conventional fractionation 4.5

  • Primary tumor

  • 5-year OS 76%

  • 5-year LC 47%

  • Recurrent tumor

  • 5-year OS 76%

  • 5-year LC 24%

There is no paper specifically reporting the outcome of relapsed chordoma treated with RT. Most series include both first line RT and salvage treatments.

N, number; pts, patients; RT, radiotherapy; FU, follow-up; CGE, cobalt gray equivalent; LRFS, local recurrence-free survival; LC, local control; RBE, relative biological effectiveness; Gy, Gray; PFS, progression-free survival; GyE, Gray equivalent; OS, overall survival; IMRT, intensity-modulated radiation therapy; LINAC, linear accelerator; R0, wide resection; R1, marginal resection; R2, intralesional resection.