Stereotactic Body Radiosurgery Associated With Rectal Displacement using Gelfoam for Sacral Chordomas: Preliminary Report of 3 Cases

Purpose: The treatment of sacral chordomas remains challenging because of high recurrence rates, postoperative complications, and limited effective radiation therapy options. We report a small case series of sacral chordoma treated exclusively with photon-based stereotactic body radiation therapy (S...

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Main Authors: Samir Abdallah Hanna, MD, MBA, PhD, Thiago Dieb Ristum Vieira, MD, Fernanda Hayashida Yoshimoto, MD, Eduardo Samir Cipriano Hanna, William Gemio Jacobsen Teixeira, MD, PhD, Douglas Kenji Narazaki, MD, PhD, Wellington Furtado Pimenta Neves-Junior, BSc, Rodrigo Ramella Munhoz, MD, PhD, Marcos Vinícius Calfat Maldaun, MD, PhD, João Luis Fernandes da Silva, MD, Gustavo Nader Marta, MD, PhD
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Advances in Radiation Oncology
Online Access:http://www.sciencedirect.com/science/article/pii/S2452109425001368
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Summary:Purpose: The treatment of sacral chordomas remains challenging because of high recurrence rates, postoperative complications, and limited effective radiation therapy options. We report a small case series of sacral chordoma treated exclusively with photon-based stereotactic body radiation therapy (SBRT), incorporating rectal displacement via tomography-guided radiointerventional interposition of a Gelfoam-based solution. This novel combination has not been previously described in the literature. Methods and Materials: Patients with biopsy-confirmed sacral conventional chordomas were included. All patients underwent SBRT with rectal displacement, receiving a single 24-Gy fraction. Treatment parameters and planning details are outlined. Results: Between 2022 and 2024, 3 patients were analyzed. Two were treatment-naïve, whereas 1 had recurrent disease. The median age was 62 years (range, 57-70). After a median follow-up of 21 months (range, 3-32), the local control rate was 100%; there were no treatment-related clinically significant adverse events (including gastrointestinal/rectal toxicities), except for 1 patient who experienced transient pain. The average dose-gradient of 1.4 Gy/mm toward the rectum because of displacement, leading to a potential reduction of the rectal dose by approximately 7 to 14 Gy. Conclusions: This small case series suggests that SBRT with rectal using a Gelfoam-based solution is a feasible and well-tolerated approach for sacral chordoma treatment. Further prospective studies with larger cohorts and extended follow-up are warranted to validate these findings and assess long-term efficacy and safety.
ISSN:2452-1094