Adida Samuel, Taori Suchet, Sefcik Roberta K, Burton Steven A, Flickinger John C, Gerszten Peter C
1School of Medicine, University of Pittsburgh.
Departments of2Neurological Surgery and.
Neurosurg Focus. 2025 May 1;58(5):E17. doi: 10.3171/2025.2.FOCUS24935.
Resection for spinal and sacral chordoma is associated with significant morbidity and high rates of local recurrence. Stereotactic radiosurgery (SRS) offers radiobiological benefits over conventional radiation therapy and has emerged as a viable treatment option for these historically radioresistant tumors. There are relatively few studies that have reported on the treatment of spinal chordoma with SRS, given its rarity. Thus, the aim of this study was to identify long-term outcomes after SRS in patients with spinal and sacral chordoma.
A prospectively collected database analysis of patients with chordomas in the mobile spine and sacrum treated with SRS was conducted at a large quaternary referral center from February 2002 to January 2024. Patient demographic and histological data, prior treatment history, dosimetry, fractionation, and outcomes, including local control (LC), overall survival (OS), and resolution of neurological deficits and pain, were identified. SRS was used alone (9 tumors, 20%), as postoperative adjuvant therapy (12 tumors, 27%), and as salvage therapy for recurrent disease (23 tumors, 52%). The median single-fraction prescription dose was 21.25 Gy (range 13.5-25 Gy). Multifractionated treatment used prescription doses of 21-42 Gy in 3-5 fractions.
Twenty-four patients (median age 65 years) with 44 chordomas were included. The median follow-up duration was 20 months (range 1-203 months). The 1-, 2-, and 5-year LC rates were 87%, 64%, and 49%, respectively. The 1- and 2-year LC rates were 100% and 83% for SRS alone and 90% and 80% for postoperative adjuvant SRS, respectively. Rates of OS were 90%, 84%, and 51% at 1, 2, and 5 years, respectively. Univariate analysis showed that multifractionated SRS was associated with superior LC (HR 0.26, 95% CI 0.10-0.71; p = 0.008); however, no significant difference in LC was observed when accounting for the biologically effective dose. Among patients presenting with neurological deficits, complete or partial resolution occurred for 8 of 20 tumors (40%). In symptomatic patients, pain was fully or partially alleviated for 27 of 36 tumors (75%). Six adverse radiation events (14%) were observed following treatment, including vertebral compression fracture (n = 2, 5%), pharyngoesophageal toxicity (n = 1, 2%), and transient peripheral neuropathy (n = 1, 2%).
This series is among the largest to date evaluating outcomes of SRS for spinal and sacral chordomas, demonstrating durable LC and symptom relief with acceptable rates of toxicity when used alone and as an adjunct to surgery. SRS is also an effective treatment option for patients with recurrent disease who seek noninvasive treatment or are not candidates for resection.
脊柱和骶骨脊索瘤切除术与显著的发病率和高局部复发率相关。立体定向放射外科（SRS）相较于传统放射治疗具有放射生物学优势，已成为这些既往对放疗耐药肿瘤的一种可行治疗选择。鉴于脊柱脊索瘤罕见，报道SRS治疗脊柱脊索瘤的研究相对较少。因此，本研究的目的是确定SRS治疗脊柱和骶骨脊索瘤患者的长期疗效。
在一家大型四级转诊中心对2002年2月至2024年1月期间接受SRS治疗的活动脊柱和骶骨脊索瘤患者进行前瞻性收集的数据库分析。确定患者的人口统计学和组织学数据、既往治疗史、剂量测定、分割方式以及疗效，包括局部控制（LC）、总生存期（OS）以及神经功能缺损和疼痛的缓解情况。SRS单独使用（9例肿瘤，20%）、作为术后辅助治疗（12例肿瘤，27%）以及作为复发性疾病的挽救治疗（23例肿瘤，52%）。单次分割处方剂量中位数为21.25 Gy（范围13.5 - 25 Gy）。多分割治疗使用的处方剂量为21 - 42 Gy，分3 - 5次。
纳入24例患者（年龄中位数65岁），共44例脊索瘤。随访时间中位数为20个月（范围1 - 203个月）。1年、2年和5年的LC率分别为87%、64%和49%。单独使用SRS的1年和2年LC率分别为100%和83%，术后辅助SRS的分别为90%和80%。1年、2年和5年的OS率分别为90%、84%和51%。单因素分析显示多分割SRS与更好的LC相关（HR 0.26，95% CI 0.10 - 0.71；p = 0.008）；然而，考虑生物等效剂量时，LC无显著差异。在出现神经功能缺损的患者中，20例肿瘤中有8例（40%）实现了完全或部分缓解。在有症状的患者中，36例肿瘤中有27例（75%）疼痛得到完全或部分缓解。治疗后观察到6例不良放射事件（14%），包括椎体压缩骨折（n = 2，5%）、咽喉食管毒性（n = 1，2%）和短暂性周围神经病变（n = 1，2%）。
本系列研究是迄今为止评估SRS治疗脊柱和骶骨脊索瘤疗效的最大规模研究之一，表明单独使用及作为手术辅助治疗时，SRS能实现持久的LC和症状缓解，且毒性发生率可接受。SRS也是寻求非侵入性治疗或不适合手术切除的复发性疾病患者的有效治疗选择。
