1
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Alexander AY, Dhawan S, Venteicher AS. Role of immunotherapy in treatment refractory chordomas: review of current evidence. Front Surg 2024; 11:1375567. [PMID: 38881706 PMCID: PMC11177759 DOI: 10.3389/fsurg.2024.1375567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Chordomas are aggressive tumors that are thought to arise from remnants of the embryological notochord. They can arise along the ventromedial aspect of the sacrum, mobile spine, and clivus-with most cases occurring in the sacrum or skull base. Despite surgery and radiation, chordomas often progress and become refractory to further treatment. The high recurrence rate of chordomas has created an urgent need to develop new systemic treatment options. Recent case reports and clinical trials have highlighted the use of immunotherapy for refractory chordomas. In this review, we summarize the results of these studies and discuss the potential role of immunotherapy for chordomas. Methods The PUBMED database was queried for studies mentioning both "Chordoma" and "Immunotherapy." All case series and case reports that involved administration of an immunotherapy for chordoma were included. Additional studies that were found during literature review were added. ClinicalTrials.Gov was queried for studies mentioning both "Chordoma" and "Immunotherapy." The final cohort consisted of all clinical trials that utilized immunotherapy for chordomas of any location. Results Eight case reports and series detailing the use of immunotherapy for treatment refractory chordoma were identified. Most patients received immunotherapy targeting the PD-1/PD-L1 interaction, and two patients received therapy targeting this interaction along with the tyrosine kinase inhibitor pazopanib. One patient received a vaccine derived from autologous tumor cells, and one patient received a viral vector that downregulated the effect of TGF-beta. One clinical trial utilized a brachyury vaccine in conjunction with standard of care radiotherapy. Conclusions Immunotherapy for chordoma is a promising area of investigation with increasing, but small, numbers of case series and clinical trials. Despite challenges in patient accrual, future directions in chordoma immunotherapy may lie in vaccine-based therapies and immune checkpoint inhibitors. Understanding chordoma heterogeneity and microenvironment will likely elucidate important chordoma features that will inform future clinical trial design.
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Affiliation(s)
- A Yohan Alexander
- Department of Neurosurgery and Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Sanjay Dhawan
- Department of Neurosurgery and Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Andrew S Venteicher
- Department of Neurosurgery and Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, United States
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2
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Kesari S, Wang F, Juarez T, Ashili S, Patro CPK, Carrillo J, Nguyen M, Truong J, Levy J, Sommer J, Freed DM, Xiu J, Takasumi Y, Bouffet E, Gill JM. Activity of pemetrexed in pre-clinical chordoma models and humans. Sci Rep 2023; 13:7317. [PMID: 37147496 PMCID: PMC10163028 DOI: 10.1038/s41598-023-34404-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
Chordomas are rare slow growing tumors, arising from embryonic remnants of notochord with a close predilection for the axial skeleton. Recurrence is common and no effective standard medical therapy exists. Thymidylate synthase (TS), an intracellular enzyme, is a key rate-limiting enzyme of DNA biosynthesis and repair which is primarily active in proliferating and metabolically active cells. Eighty-four percent of chordoma samples had loss of TS expression which may predict response to anti-folates. Pemetrexed suppresses tumor growth by inhibiting enzymes involved in folate metabolism, resulting in decreased availability of thymidine which is necessary for DNA synthesis. Pemetrexed inhibited growth in a preclinical mouse xenograft model of human chordoma. We report three cases of metastatic chordoma that had been heavily treated previously with a variety of standard therapies with poor response. In two cases, pemetrexed was added and objective responses were observed on imaging with one patient on continuous treatment for > 2 years with continued shrinkage. One case demonstrated tumor growth after treatment with pemetrexed. The two cases which had a favorable response had a loss of TS expression, whereas the one case with progressive disease had TS present. These results demonstrate the activity of pemetrexed in recurrent chordoma and warrant a prospective clinical trial which is ongoing (NCT03955042).
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Affiliation(s)
- Santosh Kesari
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA.
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
| | - Feng Wang
- Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, Chengdu, China.
| | - Tiffany Juarez
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | | | - C Pawan K Patro
- CureScience, San Diego, CA, USA
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Jose Carrillo
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Minhdan Nguyen
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Judy Truong
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Joan Levy
- Chordoma Foundation, Durham, NC, USA
| | | | | | | | - Yuki Takasumi
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Eric Bouffet
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Canada
| | - Jaya M Gill
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
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3
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Patel S, Nunna RS, Nie J, Ansari D, Chaudhry NS, Mehta AI. Incidence, Management, and Outcomes of Adult Spinal Chordoma Patients in the United States. Global Spine J 2023; 13:334-343. [PMID: 33583227 PMCID: PMC9972264 DOI: 10.1177/2192568221995155] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment. Gold standard treatment remains en-bloc surgical resection with questionable efficacy of adjuvant therapies such as radiation and chemotherapy. Here we provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chordoma. METHODS Patients with diagnosis codes specific for chordoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. RESULTS 1,548 individuals were identified with a diagnosis of chordoma, 60.9% of which were at the sacrum or coccyx and 39.1% at the spine. The mean overall survival of patients in our cohort was 8.2 years. Increased age, larger tumor size, and presence of metastases were associated with worsened overall survival. 71.2% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received proton-based radiation had significantly improved overall survival compared to traditional radiation. CONCLUSION Surgical resection significantly improves overall survival in patients with spinal chordoma. In those patients receiving radiation, those who receive proton-based modalities have improved overall survival. Further studies into proton radiotherapy doses are required.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - Ravi S. Nunna
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - James Nie
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | | | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA,Ankit I. Mehta, Department of Neurosurgery,
University of Illinois at Chicago, 912 South Wood Street, 451-N, Chicago, IL,
60612, USA.
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4
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Jenson AV, Taylor DG, Ayala A, Jackson RE, Baskin DS. Indolent multicentric chordoma – A previously undescribed entity: A Case report and literature review. Surg Neurol Int 2022; 13:348. [PMID: 36128155 PMCID: PMC9479634 DOI: 10.25259/sni_507_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Chordomas are rare neuraxial tumors arising from remnants of primitive notochord. They are generally slow-growing malignant neoplasms. Only four adult cases of multicentric chordomas have been reported, all with aggressive and rapid growth. Here, we present an unusual case of indolent multicentric chordomas involving cervical and thoracic spine, sacrum, and calvarium. Case Description: A 60-year-old male was found to have multiple lesions throughout his neuroaxis incidentally on workup for colitis. A needle biopsy documented the diagnosis of chordoma. This has been followed for more than 4 years with no progression. Conclusion: We present the first reported case of indolent multicentric chordomas. Due to the extreme rarity of indolent multicentric chordomas, close follow-up is needed and recommended.
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Affiliation(s)
- Amanda Vilate Jenson
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, United States
| | - Daniel G. Taylor
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, United States
| | - Alberto Ayala
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, United States
| | - Robert Evan Jackson
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, United States
| | - David S. Baskin
- Kenneth R. Peak Presidential Distinguished Chair Vice Chairman and Residency Program Director Department of Neurosurgery Director, Kenneth R. Peak Brain and Pituitary Tumor Treatment Center Professor of Neurosurgery, The Houston Methodist Research Institute, Weill Cornell Medical College and Texas A&M Medical School, Houston, Texas, United States
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5
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Heft Neal ME, Michmerhuizen NL, Kovatch KJ, Owen JHJ, Zhai J, Jiang H, McKean EL, Prince ME, Brenner JC. Advancement of PI3 Kinase Inhibitor Combination Therapies for PI3K-Aberrant Chordoma. J Neurol Surg B Skull Base 2022; 83:87-98. [PMID: 35155075 PMCID: PMC8824629 DOI: 10.1055/s-0040-1716694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
Abstract
Objectives Targeted inhibitors of the PI3 kinase (PI3K) pathway have shown promising but incomplete antitumor activity in preclinical chordoma models. The aim of this study is to advance methodology for a high-throughput drug screen using chordoma models to identify new combination therapies for chordoma. Study Design Present work is an in vitro study. Setting The study conducted at an academic research laboratory. Materials and Methods An in vitro study on automated high-throughput screening of chordoma cells was performed using a library of 1,406 drugs as both mono- and combination therapies with PI3K inhibitors. Combination indices were determined for dual therapies and synergistic outliers were identified as potential therapeutic agents. T (brachyury) siRNA knockdown in combination with PI3K pathway inhibition was also assessed. Results Fifty-nine combination therapies were identified as having potential therapeutic efficacy. Effective combinations included PI3K inhibitors with GSK1838705A (ALK/IGF-1R inhibitor), LY2874455 (VEGFR/FGFR inhibitor), El1 (selective Ezh2 inhibitor), and (-)-p-bromotetramisole oxalate (alkaline phosphatase inhibitor). The top ranking targets identified included ALK, PDGFR, VEGFR, aurora kinase, and BCL-2. T (brachyury) inhibition produced significant reduction in cell viability and growth; however PI3K inhibition in combination with T (brachyury) knockdown did not result in further reduction in growth and viability in vitro. Conclusion High throughput with in vitro combination screening is feasible with chordoma cells and allows for rapid identification of synergistic dual-therapies. Potential combination therapies and targetable pathways were identified. T (brachyury) knockdown produced significant reduction in cell viability, but did not show additional benefit with PI3K pathway inhibition in this model. Further in vitro and in vivo validation of these therapeutic combinations is warranted.
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Affiliation(s)
- Molly E. Heft Neal
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Nicole L. Michmerhuizen
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Kevin J. Kovatch
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - John Henry J. Owen
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Jingyi Zhai
- Department of Biostatistics, School of Public Heath, University of Michigan, Ann Arbor, Michigan, United States
| | - Hui Jiang
- Department of Biostatistics, School of Public Heath, University of Michigan, Ann Arbor, Michigan, United States
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Erin L. McKean
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Mark E.P. Prince
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - J. Chad Brenner
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, United States
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
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6
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Yuan W, Wei F, Ouyang H, Ren X, Hang J, Mo X, Liu Z. CMTM3 suppresses chordoma progress through EGFR/STAT3 regulated EMT and TP53 signaling pathway. Cancer Cell Int 2021; 21:510. [PMID: 34560882 PMCID: PMC8461898 DOI: 10.1186/s12935-021-02159-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/18/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Chordomas are rare, slow-growing and locally aggressive bone sarcomas. At present, chordomas are difficult to manage due to their high recurrence rate, metastasis tendency and poor prognosis. The underlying mechanisms of chordoma tumorigenesis and progression urgently need to be explored to find the effective therapeutic targets. Our previous data demonstrates that EGFR plays important roles in chordoma development and CKLF-like MARVEL transmembrane domain containing (CMTM)3 suppresses gastric cancer metastasis by inhibiting the EGFR/STAT3/EMT signaling pathway. However, the roles and mechanism of CMTM3 in chordomas remain unknown. METHODS Primary chordoma tissues and the paired adjacent non-tumor tissues were collected to examine the expression of CMTM3 by western blot. The expression of CMTM3 in chordoma cell lines was tested by Real-time PCR and western blot. CCK-8 and colony forming unit assay were performed to delineate the roles of CMTM3 in cell proliferation. Wound healing and Transwell assays were performed to assess cell migration and invasion abilities. A xenograft model in NSG mice was used to elucidate the function of CMTM3 in vivo. Signaling pathways were analyzed by western blot and IHC. RNA-seq was performed to further explore the mechanism regulated by CMTM3 in chordoma cells. RESULTS CMTM3 expression was downregulated in chordoma tissues compared with paired normal tissues. CMTM3 suppressed proliferation, migration and invasion of chordoma cells in vitro and inhibited tumor growth in vivo. CMTM3 accelerated EGFR degradation, suppressed EGFR/STAT3/EMT signaling pathway, upregulated TP53 expression and enriched the TP53 signaling pathway in chordoma cells. CONCLUSIONS CMTM3 inhibited tumorigenesis and development of chordomas through activating the TP53 signaling pathway and suppressing the EGFR/STAT3 signaling pathway, which suppressed EMT progression. CMTM3 might be a potential therapeutic target for chordomas.
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Affiliation(s)
- Wanqiong Yuan
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Xiaoqing Ren
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China
| | - Jing Hang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Beijing, China. .,Peking University Third Hospital, Key Laboratory of Assisted Reproduction, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China.
| | - Xiaoning Mo
- Department of Immunology, Key Laboratory of Medical Immunology, Ministry of Health, School of Basic Medical Sciences, Peking University Center for Human Disease Genomics, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Beijing Key Laboratory of Spinal Disease, Beijing, China. .,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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7
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Clinical Outcome of Sacral Chordoma Patients Treated with Pencil Beam Scanning Proton Therapy. Clin Oncol (R Coll Radiol) 2021; 33:e578-e585. [PMID: 34340918 DOI: 10.1016/j.clon.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/25/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022]
Abstract
AIMS Sacral chordomas are locally aggressive, radio-resistant tumours. Proton therapy has the potential to deliver high radiation doses, which may improve the therapeutic ratio when compared with conventional radiotherapy. We assessed tumour control and radiation-induced toxicity in a cohort of sacral chordoma patients treated with definitive or postoperative pencil beam scanning proton therapy. METHODS AND MATERIALS Sixty patients with histologically proven sacral chordoma treated between November 1997 and October 2018 at the Paul Scherrer Institute with postoperative (n = 50) or definitive proton therapy (n = 10) were retrospectively analysed. Only 10 (17%) patients received combined photon radiotherapy and proton therapy. Survival rates were calculated using the Kaplan-Meier actuarial method. The Log-rank test was used to compare different functions for local control, freedom from distant recurrence and overall survival. Acute and late toxicity were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS The median follow-up was 48 months (range 4-186). Local recurrence occurred in 20 (33%) patients. The 4-year local control, freedom from distant recurrence and overall survival rates were 77%, 89% and 85%, respectively. On univariate analysis, subtotal resection/biopsy (P = 0.02), tumour extension restricted to bone (P = 0.01) and gross tumour volume >130 ml (P = 0.04) were significant predictors for local recurrence. On multivariate analysis, tumour extension restricted to bone (P = 0.004) and gross total resection (P = 0.02) remained independent favourable prognostic factors for local recurrence. Twenty-four (40%), 28 (47%) and eight (11%) patients experienced acute grade 1, 2 and 3 toxicities, respectively. The 4-year late toxicity-free survival was 91%. Two patients developed secondary malignancies to the bladder 3-7 years after proton therapy. CONCLUSIONS Our data indicate that pencil beam scanning proton therapy for sacral chordomas is both safe and effective. Gross total resection, tumour volume <130 ml and tumour restricted to the bone are favourable prognostic factors for local tumour control.
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8
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Liang S, Yang J, Lin Y, Li T, Zhao W, Zhao J, Dong C. Immune Myocarditis Overlapping With Myasthenia Gravis Due to Anti-PD-1 Treatment for a Chordoma Patient: A Case Report and Literature Review. Front Immunol 2021; 12:682262. [PMID: 34305915 PMCID: PMC8297709 DOI: 10.3389/fimmu.2021.682262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 01/06/2023] Open
Abstract
Immunotherapy begins to be widely used due to the increasing exploration and gratifying effects in multiple cancers. Chordoma, as a rare bone malignant tumor, often recurs and metastasizes after undergoing surgery and radiotherapy. Therefore, immunotherapy can be explored as an emerging, potentially effective treatment to improve the survival rate and clinical benefit of patients. However, a variety of immune-related adverse events (irAEs) cannot be avoided completely. And the immunotherapy-induced myocarditis, as a rare but fatal irAE, has been increasingly reported. Understanding the mechanism involved in irAEs can inform best practices for side effects management. Here, we firstly reported a case of immune myocarditis and subsequent myasthenia gravis (MG) following anti-PD-1 treatment for chordoma.
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Affiliation(s)
- Shujing Liang
- Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jingxian Yang
- Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yun Lin
- Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tong Li
- Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenrong Zhao
- Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chunyan Dong
- Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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9
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Xu JC, Lehrich BM, Yasaka TM, Fong BM, Hsu FPK, Kuan EC. Characteristics and overall survival in pediatric versus adult skull base chordoma: a population-based study. Childs Nerv Syst 2021; 37:1901-1908. [PMID: 33459820 DOI: 10.1007/s00381-021-05046-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Less than 5% of chordomas occur in pediatric patients. While many studies have explored the treatment and outcomes of skull base chordomas, few have focused on the differences between pediatric and adult populations. The aim of this study is to analyze the epidemiological variables and clinical outcomes between pediatric and adult skull base chordomas using a large-sample, population-based cancer database. METHODS The National Cancer Database was queried between 2004 and 2015 for skull base chordomas. We stratified patients as pediatric (<18 years) and adults (≥18 years). We compared several clinical covariates between the two groups. RESULTS Our cohort consisted of 658 patients, 61 pediatric (9.3%), and 597 adults (90.7%). Pediatric patients were more likely to have larger tumor size (41.4 ± 15.7 mm versus 34.1 ± 15.8 mm, p < 0.01) and universally treated at academic facilities. There was no significant difference in overall survival. CONCLUSIONS Pediatric skull base chordomas are rare tumors that are managed with aggressive surgical resection, followed by radiation. While there may be difference between tumor presentation, outcomes between pediatric and adult patients are similar.
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Affiliation(s)
- Jordan C Xu
- Department of Neurosurgery, University of California, Irvine, CA, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Brendan M Fong
- Department of Neurosurgery, University of California, Irvine, CA, USA
| | - Frank P K Hsu
- Department of Neurosurgery, University of California, Irvine, CA, USA
| | - Edward C Kuan
- Department of Neurosurgery, University of California, Irvine, CA, USA. .,Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
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10
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Hoffman SE, Al Abdulmohsen SA, Gupta S, Hauser BM, Meredith DM, Dunn IF, Bi WL. Translational Windows in Chordoma: A Target Appraisal. Front Neurol 2020; 11:657. [PMID: 32733369 PMCID: PMC7360834 DOI: 10.3389/fneur.2020.00657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
Chordomas are rare tumors that are notoriously refractory to chemotherapy and radiotherapy when radical surgical resection is not achieved or upon recurrence after maximally aggressive treatment. The study of chordomas has been complicated by small patient cohorts and few available model systems due to the rarity of these tumors. Emerging next-generation sequencing technologies have broadened understanding of this disease by implicating novel pathways for possible targeted therapy. Mutations in cell-cycle regulation and chromatin remodeling genes have been identified in chordomas, but their significance remains unknown. Investigation of the immune microenvironment of these tumors suggests that checkpoint protein expression may influence prognosis, and adjuvant immunotherapy may improve patient outcome. Finally, growing evidence supports aberrant growth factor signaling as potential pathogenic mechanisms in chordoma. In this review, we characterize the impact on treatment opportunities offered by the genomic and immunologic landscape of this tumor.
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Affiliation(s)
- Samantha E Hoffman
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Sally A Al Abdulmohsen
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Saksham Gupta
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Blake M Hauser
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - David M Meredith
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, United States
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
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11
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Abstract
Bone sarcomas are rare tumors arising in bone, representing only a small fraction of solid malignant tumors. Desmoids are benign, infiltrative soft tissue neoplasms. Because of their scarcity and a paucity of data, the management of these tumors can be challenging, especially for clinicians who infrequently encounter these tumors. This article reviews the current literature regarding the diagnosis, work-up, and treatment of these uncommon mesenchymal tumors.
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Affiliation(s)
- Jeremy M Brownstein
- Francis H. Burr Proton Beam Therapy Center, Massachusetts General Hospital, 30 Fruit Street, Boston, MA 02114, USA; Department of Radiation Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Thomas F DeLaney
- Department of Radiation Oncology, Harvard Medical School, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, 30 Fruit Street, Boston, MA 02114, USA.
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12
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Sasaki R, Demizu Y, Yamashita T, Komatsu S, Akasaka H, Miyawaki D, Yoshida K, Wang T, Okimoto T, Fukumoto T. First-In-Human Phase 1 Study of a Nonwoven Fabric Bioabsorbable Spacer for Particle Therapy: Space-Making Particle Therapy (SMPT). Adv Radiat Oncol 2019; 4:729-737. [PMID: 31673666 PMCID: PMC6817542 DOI: 10.1016/j.adro.2019.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 11/03/2022] Open
Abstract
Purpose Surgical spacer placement (SSP) is useful in particle therapy (PT) for patients with abdominal or pelvic tumors located adjacent to normal organs. We developed a nonwoven fabric bioabsorbable spacer made of polyglycolic acid (PGA) sutures that degrades via hydrolysis. We then conducted this first-in-human phase 1 study of the combination of SSP and PT using the PGA spacer, which we termed space-making PT (SMPT). This study aimed to evaluate the safety and efficacy of SMPT in patients with unresectable malignant tumor located adjacent to normal organs. Methods and Materials The eligibility criteria included histologically proven malignant abdominal or pelvic tumor adjacent to the intestines, no metastasis, and no previous radiation therapy. Periodic computed tomography (CT) images were obtained before SSP and before, during, and after PT until the spacer disappeared. Treatment planning was performed for each CT image set until the end of PT, and doses for the planning target volume and organs at risk were analyzed. The thickness and volume of the PGA spacer were measured in each CT image set. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. Results Five patients were enrolled in this study. All patients received 70.4 Gy (relative biological effectiveness) of irradiation. V95% of the planning target volume before SSP, at the beginning of PT, and at the end of PT was 82.1% ± 11.3%, 98.1% ± 1.1%, and 97.1% ± 0.8%, respectively. The PGA spacers maintained enough thickness (≥1 cm) until the end of PT and disappeared within 8 months after SSP in all patients. No grade ≥3 acute adverse events were observed. Conclusions The SMPT is feasible and useful for abdominal or pelvic tumors adjacent to the intestines. This method may be applicable to unresectable tumors located adjacent to normal organs and may expand the indications of PT.
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Affiliation(s)
- Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yusuke Demizu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo, Japan.,Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - Tomohiro Yamashita
- Department of Radiation Physics, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo, Japan
| | - Shohei Komatsu
- Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroaki Akasaka
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenji Yoshida
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tianyuan Wang
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoaki Okimoto
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo, Japan
| | - Takumi Fukumoto
- Department of Radiation Physics, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo, Japan
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Dea N, Fisher CG, Reynolds JJ, Schwab JH, Rhines LD, Gokaslan ZL, Bettegowda C, Sahgal A, Lazáry Á, Luzzati A, Boriani S, Gasbarrini A, Laufer I, Charest-Morin R, Wei F, Teixeira W, Germscheid NM, Hornicek FJ, DeLaney TF, Shin JH. Current treatment strategy for newly diagnosed chordoma of the mobile spine and sacrum: results of an international survey. J Neurosurg Spine 2019; 30:119-125. [PMID: 30497218 DOI: 10.3171/2018.6.spine18362] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to investigate the spectrum of current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum.METHODSA survey on the treatment of spinal chordoma was distributed electronically to members of the AOSpine Knowledge Forum Tumor, including neurosurgeons, orthopedic surgeons, and radiation oncologists from North America, South America, Europe, Asia, and Australia. Survey participants were pre-identified clinicians from centers with expertise in the treatment of spinal tumors. The suvey responses were analyzed using descriptive statistics.RESULTSThirty-nine of 43 (91%) participants completed the survey. Most (80%) indicated that they favor en bloc resection without preoperative neoadjuvant radiation therapy (RT) when en bloc resection is feasible with acceptable morbidity. The main area of disagreement was with the role of postoperative RT, where 41% preferred giving RT only if positive margins were achieved and 38% preferred giving RT irrespective of margin status. When en bloc resection would result in significant morbidity, 33% preferred planned intralesional resection followed by RT, and 33% preferred giving neoadjuvant RT prior to surgery. In total, 8 treatment protocols were identified: 3 in which en bloc resection is feasible with acceptable morbidity and 5 in which en bloc resection would result in significant morbidity.CONCLUSIONSThe results confirm that there is treatment variability across centers worldwide for managing newly diagnosed chordoma of the mobile spine and sacrum. This information will be used to design an international prospective cohort study to determine the most appropriate treatment strategy for patients with spinal chordoma.
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Affiliation(s)
- Nicolas Dea
- 1Division of Spine Surgery, Vancouver General Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1Division of Spine Surgery, Vancouver General Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeremy J Reynolds
- 2Oxford Spinal Unit, Oxford University Hospital, Oxford, United Kingdom
| | - Joseph H Schwab
- 3Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts
| | - Laurence D Rhines
- 4Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ziya L Gokaslan
- 5Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, and The Miriam Hospital, Providence, Rhode Island
| | - Chetan Bettegowda
- 6Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arjun Sahgal
- 7Department of Radiation Oncology, University of Toronto and Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Áron Lazáry
- 8National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Alessandro Luzzati
- 9Centro Di Chirurgia Oncologia Ortopedica e Ricostruttiva del Rachide (CCOORR) and
| | - Stefano Boriani
- 10GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alessandro Gasbarrini
- 11Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Ilya Laufer
- 12Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Feng Wei
- 14Department of Orthopaedics, Peking University Third Hospital, HaiDian District, Beijing, China
| | - William Teixeira
- 15Department of Neurosurgery, Institute of Cancer of the State of São Paulo, São Paulo, Brazil
| | | | - Francis J Hornicek
- 17Department of Orthopaedic Surgery, University of California, Los Angeles Medical Center, Los Angeles, California; and
| | | | - John H Shin
- 19Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
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14
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Clinicopathologic characteristics of poorly differentiated chordoma. Mod Pathol 2018; 31:1237-1245. [PMID: 29483606 DOI: 10.1038/s41379-018-0002-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/27/2017] [Accepted: 12/03/2017] [Indexed: 12/17/2022]
Abstract
Chordoma is a rare malignant tumor of bone with high morbidity and mortality. Recently, aggressive pediatric poorly differentiated chordoma with SMARCB1 loss has been described. This study summarizes the clinicopathologic features of poorly differentiated chordoma with SMARCB1 loss in the largest series to date. A search of records between 1990-2017 at MGH identified 19 patients with poorly differentiated chordoma. Immunohistochemical stains were evaluated. Kaplan-Meier survival statistics and log-rank (Mantel Cox) tests compared survival with other subtypes. The patients (n = 19) were diagnosed at a median age of 11 years (range: 1-29). Tumors arose in the skull base and clivus (n = 10/19; 53%); cervical spine (n = 6/19; 32%); and sacrum or coccyx (n = 3/19; 16%). The clinical stage of these patients (AJCC 7e) was stage 2A (n = 7/16; 44%); stage 2B (n = 6/16; 38%); stage 4A (n = 1/16; 6%); and stage 4B (n = 2/16; 13%). The tumors were composed of sheets of epithelioid cells with nuclear pleomorphism, abundant eosinophilic cytoplasm, and increased mitoses. Tumors were positive for cytokeratin (n = 18/18; 100%) and brachyury (n = 18/18; 100%). Patients were treated with a combination of excision, radiation therapy, and chemotherapy. No difference in overall survival, progression free survival, local control time, and metastasis free survival was identified between poorly differentiated chordoma of the skull base and of the spine. Compared to other chordoma subtypes, poorly differentiated chordoma has a significantly decreased mean overall survival after stratification by site (p = 0.037). Pediatric poorly differentiated chordoma has a distinct clinical and immunohistochemical profile, with characteristic SMARCB1 loss and decreased survival compared to conventional/chondroid chordoma. Recognition of this subtype is important because these malignancies should be treated aggressively with multimodality therapy.
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Abstract
Chordoma, a rare bone tumor that occurs along the spine, has led scientists on a fascinating journey of discoveries. In this historical vignette, the authors track these discoveries in diagnosis and treatment, noting events and clinicians that played pivotal roles in our current understanding of chordoma. The study of chordoma begins in 1846 when Rudolf Virchow first observed its occurrence on a dorsum sellae; he coined the term “chordomata” 11 years later. The chordoma’s origin was greatly disputed by members of the scientific community. Eventually, Müller’s notochord hypothesis was accepted 36 years after its proposal. Chordomas were considered benign and slow growing until the early 1900s, when reported autopsy cases drew attention to their possible malignant nature. Between 1864 and 1919, the first-ever symptomatic descriptions of various forms of chordoma were reported, with the subsequent characterization of chordoma histology and the establishment of classification criteria shortly thereafter. The authors discuss the critical historical steps in diagnosis and treatment, as well as pioneering operations and treatment modalities, noting the physicians and cases responsible for advancing our understanding of chordoma.
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Affiliation(s)
| | | | - Amin Mahmoodi
- 2Division of Neurotrauma, Department of Neurological Surgery, University of California, Irvine, California
| | - Jefferson W. Chen
- 1School of Medicine and
- 2Division of Neurotrauma, Department of Neurological Surgery, University of California, Irvine, California
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16
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Abstract
Chordoma is a locally aggressive primary malignancy of the axial skeleton. The gold standard for treatment is en bloc resection, with some centers now advocating for the use of radiation to help mitigate the risk of recurrence. Local recurrence is common, and salvaging local failures is quite difficult. Chemotherapy has been ineffective and small molecule targeted therapy has had only marginal benefits in small subsets of patients with rare tumor phenotypes or refractory disease. Recent successes utilizing immunotherapy in a variety of cancers has led to a resurgence of interest in modifying the host immune system to develop new ways to treat tumors. This review will discuss these studies and will highlight the early studies employing immune strategies for the treatment of chordoma.
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Affiliation(s)
- Shalin S Patel
- Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, 55 Fruit Street Yawkey Building Suite 3A, Boston, MA, 02114-2696, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, 55 Fruit Street Yawkey Building Suite 3A, Boston, MA, 02114-2696, USA.
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17
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Mavrogenis AF, Angelini A, Panagopoulos GN, Pala E, Calabrò T, Igoumenou VG, Katzouraki G, Megaloikonomos PD, Pneumaticos SG, Papagelopoulos PJ, Ruggieri P. Aggressive Chordomas: Clinical Outcome of 13 Patients. Orthopedics 2017; 40:e248-e254. [PMID: 27841927 DOI: 10.3928/01477447-20161108-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/26/2016] [Indexed: 02/03/2023]
Abstract
The authors reviewed the files of all patients with chordomas who were admitted and treated at their institutions from 1975 to 2012. Patients were categorized by early local recurrence and metastasis. Aggressive clinical behavior was defined as local recurrence and metastasis within 24 months of diagnosis and adequate treatment (wide en bloc resection with microscopically negative tumor margins). According to these criteria, 13 patients (14.3%) had aggressive chordomas, including 7 men and 6 women, with mean age of 54 years (range, 37-65 years) at diagnosis and treatment. All patients had preoperative tumor biopsy, followed by resection with partial (7 patients) or total sacrectomy (6 patients). In all cases, biopsy and histologic analysis of resected tumor specimens showed conventional chordomas. Resection margins were wide (grossly negative) in 6 patients and wide contaminated in 7 patients. Mean maximum tumor diameter was 11.8 cm (range, 5-21 cm). Mean follow-up was 43 months (range, 8-131 months). Rates of local recurrence, metastasis, and death were evaluated. At the last follow-up, all patients had local recurrence at a mean of 13 months (range, 5-22 months). Histologic examination of recurrent tumors showed a dedifferentiated chordoma with a fibrosarcoma component in 2 patients and no histologic change in the remaining patients. In addition, 8 patients had metastases at a mean of 13 months (range, 4-24 months) and died of their disease. All histologic findings of metastatic lesions were similar to those of primary tumors. Early diagnosis of aggressive tumors requires close follow-up of patients with chordomas. Metastasis is common, with resultant poor survival. [Orthopedics. 2017; 40(2):e248-e254.].
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18
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Bişkin S, Erdemir RU, Eliçora SŞ, Aydinli S, Özdamar ŞO. Metastatic Chordoma of the Tongue: Case Report. EAR, NOSE & THROAT JOURNAL 2017. [DOI: 10.1177/014556131709600316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chordomas are rare bone tumors that arise from notochord remnants. They most commonly occur in the sacrum, but they also can be seen in the skull base, cervical spine, and thoracolumbar vertebrae. Chordomas account for 1 to 4% of all primary skeletal tumors. They are usually indolent, locally growing tumors. Distant metastasis has been reported in 3 to 48% of cases. When metastasis occurs, it is usually observed in the lung, bone, and liver. To the best of our knowledge, no case of a chordoma metastasis to the tongue has been previously reported in the literature. We report such a case in a 61-year-old man.
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Affiliation(s)
- Sultan Bişkin
- Department of Otorhinolaryngology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Rabiye Uslu Erdemir
- Department of Nuclear Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Sultan Şevik Eliçora
- Department of Otorhinolaryngology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Sevim Aydinli
- Department of Otorhinolaryngology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Şükrü Oğuz Özdamar
- Department of Pathology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
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Habrand JL, Datchary J, Bolle S, Beaudré A, de Marzi L, Beccaria K, Stefan D, Grill J, Dendale R. Reprint of "Chordoma in children: Case-report and review of literature". Rep Pract Oncol Radiother 2016; 21:412-7. [PMID: 27330429 PMCID: PMC4899428 DOI: 10.1016/j.rpor.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
We report an exceptional case of a very late local failure in a 9-year-old boy presenting with a chordoma of the cranio-cervical junction. The child was initially treated with a combination of surgical resection followed by high dose photon-proton radiation therapy. This aggressive therapy allowed a 9-year remission with minimal side-effects. Unfortunately, he subsequently presented with a local failure managed with a second full-dose course of protons. The child died one year later from local bleeding of unclear etiology.
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Affiliation(s)
- Jean-Louis Habrand
- Department of Radiation Oncology, Centre François Baclesse, 3 rue du Général Harris, 14076 Caen, France
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Jean Datchary
- Department of Radiation Oncology, Centre François Baclesse, 3 rue du Général Harris, 14076 Caen, France
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Stéphanie Bolle
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Anne Beaudré
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Ludovic de Marzi
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
| | - Kévin Beccaria
- Department of Pediatric Neurosurgery, Centre Hospitalier Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Dinu Stefan
- Department of Radiation Oncology, Centre François Baclesse, 3 rue du Général Harris, 14076 Caen, France
| | - Jacques Grill
- Department of Pediatric Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Rémi Dendale
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
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20
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Wang AC, Owen JH, Abuzeid WM, Hervey-Jumper SL, He X, Gurrea M, Lin M, Altshuler DB, Keep RF, Prince ME, Carey TE, Fan X, McKean EL, Sullivan SE. STAT3 Inhibition as a Therapeutic Strategy for Chordoma. J Neurol Surg B Skull Base 2016; 77:510-520. [PMID: 27857879 DOI: 10.1055/s-0036-1584198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/17/2016] [Indexed: 12/24/2022] Open
Abstract
Objective Signal transducer and activator of transcription (STAT) proteins regulate key cellular fate decisions including proliferation and apoptosis. STAT3 overexpression induces tumor growth in multiple neoplasms. STAT3 is constitutively activated in chordoma, a tumor with a high recurrence rate despite maximal surgical and radiation treatment. We hypothesized that a novel small molecule inhibitor of STAT3 (FLLL32) would induce significant cytotoxicity in sacral and clival chordoma cells. Methods Sacral (UCh1) and clival (UM-CHOR-1) chordoma cell lines were grown in culture (the latter derived from primary tumor explants). FLLL32 dosing parameters were optimized using cell viability assays. Antitumor potential of FLLL32 was assessed using clonal proliferation assays. Potential mechanisms underlying observed cytotoxicity were examined using immunofluorescence assays. Results FLLL32 induced significant cytotoxicity in UCh1 and UM-CHOR-1 chordoma cells, essentially eliminating all viable cells, correlating with observed downregulation in activated, phosphorylated STAT3 upon administration of FLLL32. Mechanisms underlying the observed cytotoxicity included increased apoptosis and reduced cellular proliferation through inhibition of mitosis. Conclusion As a monotherapy, FLLL32 induces potent tumor kill in vitro in chordoma cell lines derived from skull base and sacrum. This effect is mediated through inhibition of STAT3 phosphorylation, increased susceptibility to apoptosis, and suppression of cell proliferation.
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Affiliation(s)
- Anthony C Wang
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - John H Owen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Shawn L Hervey-Jumper
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Xiaobing He
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Mikel Gurrea
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Meijuan Lin
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - David B Altshuler
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Mark E Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Thomas E Carey
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Xing Fan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States; Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan, United States
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
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21
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Habrand JL, Datchary J, Bolle S, Beaudré A, de Marzi L, Beccaria K, Stefan D, Grill J, Dendale R. Chordoma in children: Case-report and review of literature. Rep Pract Oncol Radiother 2016; 21:1-7. [PMID: 26900351 PMCID: PMC4716407 DOI: 10.1016/j.rpor.2015.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/21/2015] [Indexed: 11/29/2022] Open
Abstract
We report an exceptional case of a very late local failure in a 9-year-old boy presenting with a chordoma of the cranio-cervical junction. The child was initially treated with a combination of surgical resection followed by high dose photon-proton radiation therapy. This aggressive therapy allowed a 9-year remission with minimal side-effects. Unfortunately, he subsequently presented with a local failure managed with a second full-dose course of protons. The child died one year later from local bleeding of unclear etiology.
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Affiliation(s)
- Jean-Louis Habrand
- Department of Radiation Oncology, Centre François Baclesse, 3 rue du Général Harris, 14076 Caen, France
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Jean Datchary
- Department of Radiation Oncology, Centre François Baclesse, 3 rue du Général Harris, 14076 Caen, France
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Stéphanie Bolle
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Anne Beaudré
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Ludovic de Marzi
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
| | - Kévin Beccaria
- Department of Pediatric Neurosurgery, Centre Hospitalier Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Dinu Stefan
- Department of Radiation Oncology, Centre François Baclesse, 3 rue du Général Harris, 14076 Caen, France
| | - Jacques Grill
- Department of Pediatric Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Rémi Dendale
- Department of Radiation Oncology, Institut Curie Protontherapy Center, Campus universitaire, 91406 Orsay, France
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Lau CSM, Mahendraraj K, Ward A, Chamberlain RS. Pediatric Chordomas: A Population-Based Clinical Outcome Study Involving 86 Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1973-2011). Pediatr Neurosurg 2016; 51:127-36. [PMID: 26881831 DOI: 10.1159/000442990] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Primary chordomas, rare cancers arising from the notochord remnants, are extremely rare in the pediatric population. This study examined a large cohort of primary chordoma patients to determine factors impacting prognosis and survival. METHODS Demographic and clinical data on 1,358 primary chordoma patients (86 pediatric patients ≤19 years of age and 1,272 adult patients ≥20 years of age) were abstracted from the Surveillance, Epidemiology, and End Result (SEER) database (1973-2011). RESULTS Pediatric primary chordomas present most often as small tumors <4 cm in the cranium of male Caucasians. Despite the majority of primary chordomas presenting with locoregional involvement (90.4%), pediatric patients had more distant disease (14.8 vs. 9.2%, p < 0.05). Survival among pediatric patients having surgery only was significantly longer than for adults (22.5 vs. 14.3 years, p < 0.001). Overall survival was longer (17.2 vs. 12.6 years) and overall mortality was lower in pediatric patients (38.4 vs. 49.8%), but cancer-specific mortality was higher (37.2 vs. 28.6%, p < 0.005). CONCLUSIONS Pediatric primary chordomas present most often as small tumors <4 cm in the cranium of male Caucasians. Despite having a higher rate of metastasis, they have prolonged survival compared to adults. Surgical resection significantly improves survival in pediatric primary chordoma patients, and should be considered as first-line therapy in all eligible children.
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Affiliation(s)
- Christine S M Lau
- Department of Surgery, Saint Barnabas Medical Center, Livingston, N.J., USA
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23
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Fatehi Hassanabad M, Mansouri A, Alotaibi NM, Hazrati LN, Bernstein M. Metastatic saccrococcygeal chordoma. J Clin Neurosci 2015; 23:149-152. [PMID: 26602601 DOI: 10.1016/j.jocn.2015.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/02/2015] [Indexed: 10/22/2022]
Abstract
We report a 46-year-old man who presented with a 2week history of worsening headaches and acute onset left sided hemiplegia. He had undergone a surgical resection of a sacral chordoma 13years prior, followed by adjuvant radiotherapy and chemotherapy. MRI revealed multiple enhancing lesions in the brain, and the two largest were resected. The histopathology was consistent with chordoma. Sacrococcygeal chordomas are locally invasive notochord-related sarcomas. They rarely metastasize to the brain, and only eight patients have been reported. While currently available adjuvant radiotherapy and systemic chemotherapeutic regimens can be implemented in the management of these rare patients, they have shown limited success. The newer strategies that are reported here have also been disappointing.
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Affiliation(s)
| | | | | | - Lili-Naz Hazrati
- Division of Pathology, University Health Network, Toronto, Canada
| | - Mark Bernstein
- Division of Neurosurgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
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Vogin G, Calugaru V, Bolle S, George B, Oldrini G, Habrand JL, Mammar H, Dendale R, Salleron J, Noël G, Feuvret L. Investigation of ectopic recurrent skull base and cervical chordomas: The Institut Curie's proton therapy center experience. Head Neck 2015; 38 Suppl 1:E1238-46. [DOI: 10.1002/hed.24199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/11/2015] [Accepted: 07/07/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Guillaume Vogin
- Department of Radiation Oncology; Institut de Cancérologie de Lorraine; Nancy France
| | - Valentin Calugaru
- Department of Radiation Oncology; Institut Curie; Paris France
- Protontherapy Center; Institut Curie; Orsay France
| | - Stéphanie Bolle
- Department of Radiation Oncology; Institut Gustave Roussy; Villejuif France
- Protontherapy Center; Institut Curie; Orsay France
| | - Bernard George
- Department of Neurosurgery; Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris; Paris France
| | - Guillaume Oldrini
- Department of Radiology; Institut de Cancérologie de Lorraine; Nancy France
| | - Jean-Louis Habrand
- Department of Radiation Oncology; Centre François Baclesse; Caen France
- Protontherapy Center; Institut Curie; Orsay France
| | - Hamid Mammar
- Department of Radiation Oncology; Institut Curie; Paris France
- Protontherapy Center; Institut Curie; Orsay France
| | - Rémi Dendale
- Department of Radiation Oncology; Institut Curie; Paris France
- Protontherapy Center; Institut Curie; Orsay France
| | - Julia Salleron
- Department of Biostatistics; Institut de Cancérologie de Lorraine; Nancy France
| | - Georges Noël
- Department of Radiation Oncology; Centre Paul Strauss; Strasbourg France
| | - Loïc Feuvret
- Protontherapy Center; Institut Curie; Orsay France
- Department of Radiation Oncology; Hôpital La Pitié Salpétrière, Assistance Publique - Hôpitaux de Paris; Paris France
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Rotondo RL, Folkert W, Liebsch NJ, Chen YLE, Pedlow FX, Schwab JH, Rosenberg AE, Nielsen GP, Szymonifka J, Ferreira AE, Hornicek FJ, DeLaney TF. High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors. J Neurosurg Spine 2015; 23:788-97. [PMID: 26340383 DOI: 10.3171/2015.3.spine14716] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. RESULTS Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for R0/R1 margins and the absence of intralesional procedures. CONCLUSIONS High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jackie Szymonifka
- Division of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Angelini A, Pala E, Calabrò T, Maraldi M, Ruggieri P. Prognostic factors in surgical resection of sacral chordoma. J Surg Oncol 2015; 112:344-51. [PMID: 26238085 DOI: 10.1002/jso.23987] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 07/14/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The best treatment of sacral chordoma is surgical resection, nowadays associated with optimized radiation therapy. We analysed 1) the oncologic outcome in a large series; 2) the effect of previous intralesional surgery, resection level, tumor volume and margins on survivorship to local recurrence (LR) and 3) the complication rate. METHODS We reviewed 71 patients with sacral chordomas. Forty-eight resections were proximal to S3. Mean tumor volume was 535 cm3. Eleven received previous intralesional surgery elsewhere. Margins were wide in 44 resections, wide-contaminated in 11, marginal in 9 and intralesional in 7. RESULTS Overall survival was 92%, 65% and 44% at 5, 10 and 15 years. At a mean of 9.5 years 37 were NED (54.4%), 23 died with disease (33.8%) and 8 were alive with disease (11.7%). Relapses included 15 LRs, 6 distant metastases, 17 both. LR rate was significantly higher in patients with previous surgery (p=0.0217), with inadequate margins (p= 0.0339) and large tumors(p<0.01), whereas resection level was not significant. Multivariate analysis confirmed the role of tumor volume. Complication rate was high (80.9%) with an infection rate of 41.2%. CONCLUSIONS The most prominent adverse factor for LR was previous intralesional surgery. LR rate was related with inadequate margins and tumor volume.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Elisa Pala
- Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Teresa Calabrò
- Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Marco Maraldi
- Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Pietro Ruggieri
- Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
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27
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Rohatgi S, Ramaiya NH, Jagannathan JP, Howard SA, Shinagare AB, Krajewski KM. Metastatic Chordoma: Report of the Two Cases and Review of the Literature. Eurasian J Med 2015; 47:151-4. [PMID: 26180502 DOI: 10.5152/eurasianjmed.2015.52] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/07/2014] [Indexed: 11/22/2022] Open
Abstract
Chordomas are rare malignant bone tumours with a predilection for the axial skeleton, especially the sacrum and skull base. Median survival in patients with metastatic disease is usually dismal. Treatment is challenging due to the propensity for local recurrence, metastatic disease as well as lack of clear consensus regarding the optimal management. Our case report highlights two cases of sacral chordoma with locally recurrent and widespread metastatic disease, stable on molecular targeted therapy.
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Affiliation(s)
- Saurabh Rohatgi
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Nikhil H Ramaiya
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Jyothi P Jagannathan
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Stephanie A Howard
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Atul B Shinagare
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Katherine M Krajewski
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
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28
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Carbon ion beam radiotherapy for sinonasal malignant tumors invading skull base. Case Rep Otolaryngol 2014; 2014:241856. [PMID: 25013734 PMCID: PMC4070444 DOI: 10.1155/2014/241856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/20/2014] [Indexed: 12/19/2022] Open
Abstract
Objective. To evaluate the treatment outcome and prognostic factors in patients with sinonasal malignant tumors invading skull base. Study Design and Setting. A retrospective clinical study at the Yamagata University School of Medicine. Subjects and Methods. Three patients with sinonasal malignant tumors invading skull base were presented in present study. All patients were treated with carbon ion beam radiotherapy. The prescribed dose to the center of the clinical target volume was 64.0 GyE/16 fractions over 4 weeks at 4.0 GyE/fraction per day. Results. All patients completed carbon ion beam radiotherapy without an interval. The mean observation period was 39.6 months (range: 11–54 months). There were no local or regional recurrences in all cases; however, one patient had a metastasis in distant organs. Regarding the complications, visual loss was observed in one eye of one patient whose optic nerve was entirely involved by the tumor and field of carbon ion beam radiotherapy. Radiation induced brain injury was observed in two patients; however, these patients do not complain about neurological abnormality and had no treatment for radiation induced brain necrosis. Conclusions. Carbon ion beam radiotherapy for sinonasal malignant tumors invading the skull base showed therapeutic effectiveness.
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Abstract
OBJECTIVES The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis, and surgical management of the malignant primary sacral tumors. METHODS A PubMed search was conducted using a combination of the following items: (('Spinal Neoplasms'[Mesh]) AND 'Sacrum'[Mesh]) NOT ('Metastasis' OR 'Metastases' OR 'Benign'). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. RESULTS Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and oncologic outcome, and the recurrence-free and disease-specific survival of this rare patient category. DISCUSSION Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols.
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Abstract
Chordomas are rare neoplasms that do not often metastasize. Of the small percent that do metastasize, they very infrequently involve skeletal muscle. Only a few cases of skeletal muscle metastases have been reported in the literature. We report an unusual case of a patient with a primary sacrococcygeal chordoma who experienced a long period of remission but who subsequently developed recurrence and multiple metastatic lesions to skeletal muscles including the deltoid, triceps, and pectineus.
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31
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Siu IM, Ruzevick J, Zhao Q, Connis N, Jiao Y, Bettegowda C, Xia X, Burger PC, Hann CL, Gallia GL. Erlotinib inhibits growth of a patient-derived chordoma xenograft. PLoS One 2013; 8:e78895. [PMID: 24260133 PMCID: PMC3829812 DOI: 10.1371/journal.pone.0078895] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/17/2013] [Indexed: 11/18/2022] Open
Abstract
Chordomas are rare primary bone tumors that occur along the neuraxis. Primary treatment is surgery, often followed by radiotherapy. Treatment options for patients with recurrence are limited and, notably, there are no FDA approved therapeutic agents. Development of therapeutic options has been limited by the paucity of preclinical model systems. We have established and previously reported the initial characterization of the first patient-derived chordoma xenograft model. In this study, we further characterize this model and demonstrate that it continues to resemble the original patient tumor histologically and immunohistochemically, maintains nuclear expression of brachyury, and is highly concordant with the original patient tumor by whole genome genotyping. Pathway analysis of this xenograft demonstrates activation of epidermal growth factor receptor (EGFR). In vitro studies demonstrate that two small molecule inhibitors of EGFR, erlotinib and gefitinib, inhibit proliferation of the chordoma cell line U-CH 1. We further demonstrate that erlotinib significantly inhibits chordoma growth in vivo. Evaluation of tumors post-treatment reveals that erlotinib reduces phosphorylation of EGFR. This is the first demonstration of antitumor activity in a patient-derived chordoma xenograft model and these findings support further evaluation of EGFR inhibitors in this disease.
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Affiliation(s)
- I-Mei Siu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jacob Ruzevick
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Qi Zhao
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Ludwig Collaborative Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nick Connis
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Yuchen Jiao
- Ludwig Center for Cancer Genetics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Ludwig Center for Cancer Genetics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Xuewei Xia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Neurosurgery, Affiliated Hospital of Gulin Medical College, Guilin, China
| | - Peter C. Burger
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Christine L. Hann
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Gary L. Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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32
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Trucco MM, Awad O, Wilky BA, Goldstein SD, Huang R, Walker RL, Shah P, Katuri V, Gul N, Zhu YJ, McCarthy EF, Paz-Priel I, Meltzer PS, Austin CP, Xia M, Loeb DM. A novel chordoma xenograft allows in vivo drug testing and reveals the importance of NF-κB signaling in chordoma biology. PLoS One 2013; 8:e79950. [PMID: 24223206 PMCID: PMC3819300 DOI: 10.1371/journal.pone.0079950] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 09/27/2013] [Indexed: 01/10/2023] Open
Abstract
Chordoma is a rare primary bone malignancy that arises in the skull base, spine and sacrum and originates from remnants of the notochord. These tumors are typically resistant to conventional chemotherapy, and to date there are no FDA-approved agents to treat chordoma. The lack of in vivo models of chordoma has impeded the development of new therapies for this tumor. Primary tumor from a sacral chordoma was xenografted into NOD/SCID/IL-2R γ-null mice. The xenograft is serially transplantable and was characterized by both gene expression analysis and whole genome SNP genotyping. The NIH Chemical Genomics Center performed high-throughput screening of 2,816 compounds using two established chordoma cell lines, U-CH1 and U-CH2B. The screen yielded several compounds that showed activity and two, sunitinib and bortezomib, were tested in the xenograft. Both agents slowed the growth of the xenograft tumor. Sensitivity to an inhibitor of IκB, as well as inhibition of an NF-κB gene expression signature demonstrated the importance of NF-κB signaling for chordoma growth. This serially transplantable chordoma xenograft is thus a practical model to study chordomas and perform in vivo preclinical drug testing.
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Affiliation(s)
- Matteo M. Trucco
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ola Awad
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Breelyn A. Wilky
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Seth D. Goldstein
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ruili Huang
- National Center for Advancing Translational Sciences, NIH, Rockville, Maryland, United States of America
| | - Robert L. Walker
- Genetics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Preeti Shah
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Varalakshmi Katuri
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Naheed Gul
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Yuelin J. Zhu
- Genetics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Edward F. McCarthy
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ido Paz-Priel
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Paul S. Meltzer
- Genetics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Christopher P. Austin
- National Center for Advancing Translational Sciences, NIH, Rockville, Maryland, United States of America
| | - Menghang Xia
- National Center for Advancing Translational Sciences, NIH, Rockville, Maryland, United States of America
| | - David M. Loeb
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, United States of America
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Yamada Y, Laufer I, Cox BW, Lovelock DM, Maki RG, Zatcky JM, Boland PJ, Bilsky MH. Preliminary Results of High-Dose Single-Fraction Radiotherapy for the Management of Chordomas of the Spine and Sacrum. Neurosurgery 2013; 73:673-80; discussion 680. [DOI: 10.1227/neu.0000000000000083] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
En bloc wide-margin excision significantly decreases the risk of chordoma recurrence. However, a wide surgical margin cannot be obtained in many chordomas because they arise primarily in the sacrum, clivus, and mobile spine. Furthermore, these tumors have shown resistance to fractionated photon radiation at conventional doses and numerous chemotherapies.
OBJECTIVE:
To analyze the outcomes of single-fraction stereotactic radiosurgery (SRS) in the treatment of chordomas of the mobile spine and sacrum.
METHODS:
Twenty-four patients with chordoma of the sacrum and mobile spine were treated with high-dose single-fraction SRS (median dose, 2400 cGy). Twenty-one primary and 3 metastatic tumors were treated. Seven patients were treated for postoperative tumor recurrence. In 7 patients, SRS was administered as planned adjuvant therapy, and in 13 patients, SRS was administered as neoadjuvant therapy. All patients had serial magnetic resonance imaging follow-up.
RESULTS:
The overall median follow-up was 24 months. Of the 24 patients, 23 (95%) demonstrated stable or reduced tumor burden based on serial magnetic resonance imaging. One patient had radiographic progression of tumor 11 months after SRS. Only 6 of 13 patients who underwent neoadjuvant SRS proceeded to surgery. This decision was based on the lack of radiographic progression and the patient's preference. Complications were limited to 1 patient in whom sciatic neuropathy developed and 1 with vocal cord paralysis.
CONCLUSION:
High-dose single-fraction SRS provides good tumor control with low treatment-related morbidity. Additional follow-up is required to determine the long-term recurrence risk.
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Affiliation(s)
- Yoshiya Yamada
- Departments of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ilya Laufer
- Departments of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
- Departments of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brett W. Cox
- Departments of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - D. Michael Lovelock
- Departments of Medical Physics, and Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Robert G. Maki
- Departments of Orthopedics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joan M. Zatcky
- Departments of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Patrick J. Boland
- Department of Neurologic Surgery, Weill Cornell Medical College, New York, New York
| | - Mark H. Bilsky
- Departments of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
- Departments of Medicine, Pediatrics, and Orthopedics, Mount Sinai School of Medicine, New York, New York
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Kashimura T, Adachi K, Enatsu K, Takada Y, Higuchi R. Unusual Presentation of the Retrorectal Neoplasm Masquerading as a Subcutaneous Hip Tumor. Am Surg 2012. [DOI: 10.1177/000313481207801118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tsutomu Kashimura
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan; and Department of Plastic and Reconstructive Surgery Tokyo Metropolitan Tama Medical Center Tokyo, Japan
| | - Kensuke Adachi
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo, Japan
| | - Kazuaki Enatsu
- Department of Pathology Tokyo Metropolitan Tama Medical Center Tokyo, Japan
| | - Yukari Takada
- Department of Radiology Tokyo Metropolitan Tama Medical Center Tokyo, Japan
| | - Ryouhei Higuchi
- Department of Plastic and Reconstructive Surgery Tokyo Metropolitan Tama Medical Center Tokyo, Japan
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Abstract
Chordoma is a rare bone cancer that is aggressive, locally invasive, and has a poor prognosis. Chordomas are thought to arise from transformed remnants of notochord and have a predilection for the axial skeleton, with the most common sites being the sacrum, skull base, and spine. The gold standard treatment for chordomas of the mobile spine and sacrum is en-bloc excision with wide margins and postoperative external-beam radiation therapy. Treatment of clival chordomas is unique from other locations with an enhanced emphasis on preservation of neurological function, typified by a general paradigm of maximally safe cytoreductive surgery and advanced radiation delivery techniques. In this Review, we highlight current standards in diagnosis, clinical management, and molecular characterisation of chordomas, and discuss current research.
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Wardelmann E, Chemnitz JM, Wendtner CM. Targeted Therapy of Soft Tissue Sarcomas. ACTA ACUST UNITED AC 2012; 35 Suppl 1:21-7. [DOI: 10.1159/000334958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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