Radiotherapy for chordoma

Twenty-five patients with gross residual chordoma after partial excision or biopsy were treated by radical radiotherapy at Royal Marsden Hospital between 1952 and 1981. The median duration of freedom from local progression following radiotherapy was 32 months. Twenty-four of the 25 patients (96%) had stabilization or reduction in symptoms. All 19 patients in whom pain was a major symptom had relief. The overall actuarial 5- and 10-year survival rates were 44% and 17%, respectively. The corresponding progression--free survival rates were 33% and 20%. Permanent cure was unusual with any radiotherapy dose, but doses higher than 55 Gy or a TDF of 90 were associated with a statistically significant improvement in duration of local control. Seven of 17 (41%) patients who received greater than 55 Gy had freedom from local progression for 5 or more years compared with only 1 of 8 patients receiving less than 50 Gy. Subtotal excision prior to radiotherapy did not appear to improve median survival or probability of long-term local control. Distant metastases were seen in 16% of the patients, derived entirely from sacrococcygeal lesions, but only half of these caused significant morbidity or death. Local control is obviously the overwhelming problem. High dose, generous volume radiotherapy is advocated.