Gamma knife stereotactic radiosurgery for recurrent intracranial chordoma

Keywords: gamma knife, chordoma, radiosurgery, outcome, skull base

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     Intracranial chordoma is a rare neoplasm that composes under1% of all primary brain tumor. This tumor is thought to arise from the primitive notochord remnants of the axial skeleton. Although slow growing and histologically benign, chordomas are locally aggressive and destructive tumors with high recurrence rates. Surgical resection is the primary treatment standard, but complete resection is difficult due to their invasive nature and critical location. 
     In this study we evaluated the efficacy and the role of gamma knife stereotactic radiosurgery (GKRS) for control of the recurrent intracranial chordomas.
     The mean age of these patients at first GKRS was 60.1 (range 45-72) years.
     Between April 2004 and July 2010, we treated 8 patients with 19tumors of recurrent intracranial chordoma by GKRS. All patients underwent surgical resection before GKRS and had histological confirmation of the diagnosis.  Four of these patients received repetitive GKRS and one patient was treated with fractionated external beam radiotherapy before GKRS. The mean volume of the tumors was 5.7 ml (range 0.6-13.4 ml) and the mean prescription dose to tumor margin was 16.2 Gy (range 9-20 Gy).
     The median follow-up time was 49 months (range 19-91 months). Of 19 treated tumors which were followed up more than 12 months, 14 were decreased in size, 4 were remained unchanged, and one was progressed. The progression free survival rate were 100, 67 and 50% at 12, 24 and 36months after initial GKRS.
     This was a retrospective study.
     GKRS is a reasonable management option for patient with recurrent intracranial chordoma.


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