Chordoma – immediate postoperative/post-proton therapy radiosurgery for residual disease
SKULL BASE REGION
Clivus
HISTOPATHOLOGY
Chordoma
PRIOR SURGICAL RESECTION
Yes
PERTINENT LABORATORY FINDINGS
N/A
Case description
A 67-year-old female presented with persistent frontal headaches. She underwent a brain MRI, which revealed a mass centered in the left clivus, extending to the left half of the sphenoid sinus and ipsilateral pituitary fossa as well as compressing the left ventral pons ( Figure 6.26.1 ). She underwent transsphenoidal resection of the tumor and was referred for postoperative radiotherapy ( Figure 6.26.2 ). Given the extension of disease into the prepontine cistern and inability to meet treatment planning constraints with a single modality and approach, she was treated with intensity-modulated proton therapy to a dose of 73.8 Gy in 41 fractions to the primary residual tumor and resection bed, with a purposeful cold spot in the tumor extending into the prepontine cistern with a plan for a stereotactic radiosurgery (SRS) boost to this site ( Figures 6.26.3–6.26.5 ).
Radiosurgery Machine
Gamma Knife
Radiosurgery Dose (Gy)
27, at the 55% isodose line
Number of Fractions
3
Figure 6.26.1.
Axial and sagittal postcontrast T1-weighted images performed at diagnosis time, revealing a clival mass with invasion of the sphenoid sinus, left prepontine cistern, left cavernous sinus, and floor of the pituitary fossa, with mass effect and compression on the left pons.
Figure 6.26.2.
Axial and sagittal postcontrast T1-weighted images performed after transsphenoidal debulking of the clival chordoma, with residual enhancement consistent with residual tumor and persistent erosion of the floor of the sella and posterior cortex of the clivus and epidural tumor spread at the level of the pons.
Figure 6.26.3.
Axial, coronal, and sagittal treatment planning CT images with corresponding isodose legend for the initial intensity-modulated proton therapy treatment plan delivering a total dose of 73.8 Gy in 41 fractions to the primary residual tumor and resection bed with a purposeful cold spot (minimum dose 54 Gy) in the tumor extending into the prepontine cistern.
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Apr 6, 2024 | Posted by drzezo in GENERAL RADIOLOGY | Comments Off on Chordoma – immediate postoperative/post-proton therapy radiosurgery for residual disease
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