2025 Proffered Presentations
S057: HYPOFRACTIONATED RADIOSURGERY FOR SKULL BASE, SPINAL AND SACRAL CHORDOMAS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Vinay Jaikumar, MD; Jaims Lim, MD; Seth Schrader, BS; Michael Liu, BS; Hanna N Algattas, MD; Jason M Davies, MD, PhD; Kenneth V Snyder, MD, PhD; Adnan H Siddiqui, MD, PhD; Elad I Levy, MD, MBA; University at Buffalo Neurosurgery
Introduction: Chordomas’ critical locations within skullbase, spine and sacrum limit the maximal dose that can be administered to ensure tumor regression. To mitigate radiation side-effects, fractionation protocols ensure the delivery of equivalent or higher total radiation in manageable fractions, while maintaining comparable side-effect profiles. Hypofractionated stereotactic radiosurgery (HF-SRS) is a fractionation strategy that administers higher doses-per-fraction (>2Gy) necessitating fewer fractions overall, addressing potentially higher obliteration rates, low side-effects and ensuring patient compliance. We performed a systematic review and meta-analysis to evaluate the outcomes of HF-SRS utilization in the treatment of skullbase, spinal and sacral chordomas and chondrosarcomas.
Methods: PubMed and EmBase were queried for literature on ‘hypofractionated’ ‘radiosurgery’ for ‘chordomas.’ Data on patient and chordoma characteristics, procedural details, follow-up outcomes and survival were extracted from eligible studies. Meta-analyses using random-effects models were conducted on variables reported by ≥3 studies on R version 4.3.2.
Results: We included 11 studies reporting 165 patients with a mean age of 47.69 years [43.38-52.43] (Table 1-2), representing 58.04% [49.75-65.91] males. Skullbase chordomas constituted 71.23% [57.61-81.86] with an additional 23.33% [15.72-33.17] detected in the mobile spine. Chondrosarcomas formed 12.49% [5.96-24.33] of all tumors. A mean dosage of 29.74 Gy [25.40-34.82] were delivered in 4.11 [3.59-4.71] fractions at 7.60 [7.18-8.04] Gy/fraction. On mean follow-up duration of 31.22 months [19.06-51.14], we observed 10.88% [5.89-19.21] radionecrosis and 11.28% [5.29-22.50] chordoma-related mortality rate. Overall survival was 92.64% [86.65-96.07], 89.91% [80.44-95.08], and 83.29% [67.24-92.37] at 1-, 2-, and 5-years respectively, while progression-free survival respectively was 83.43% [74.36-89.73], 81.49% [72.50-88.03], and 72.47% [59.94-82.24].
Conclusion: HF-SRS is promising among radiosurgical strategies for chordoma treatment with a low complication rate, indicating promise for potential first-line use. Significant heterogeneity in dosing regimens warrants additional investigation and necessitates homogenous reporting with the incorporation location specific chordoma, treatment and survival information.