{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:52:04Z","timestamp":1792219924749,"version":"4.4.0"},"reference-count":118,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Resection for spinal and sacral chordoma is associated with significant morbidity and high rates of local recurrence. Stereotactic radiosurgery (SRS) offers radiobiological benefits over conventional radiation therapy and has emerged as a viable treatment option for these historically radioresistant tumors. There are relatively few studies that have reported on the treatment of spinal chordoma with SRS, given its rarity. Thus, the aim of this study was to identify long-term outcomes after SRS in patients with spinal and sacral chordoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A prospectively collected database analysis of patients with chordomas in the mobile spine and sacrum treated with SRS was conducted at a large quaternary referral center from February 2002 to January 2024. Patient demographic and histological data, prior treatment history, dosimetry, fractionation, and outcomes, including local control (LC), overall survival (OS), and resolution of neurological deficits and pain, were identified. SRS was used alone (9 tumors, 20%), as postoperative adjuvant therapy (12 tumors, 27%), and as salvage therapy for recurrent disease (23 tumors, 52%). The median single-fraction prescription dose was 21.25 Gy (range 13.5\u201325 Gy). Multifractionated treatment used prescription doses of 21\u201342 Gy in 3\u20135 fractions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty-four patients (median age 65 years) with 44 chordomas were included. The median follow-up duration was 20 months (range 1\u2013203 months). The 1-, 2-, and 5-year LC rates were 87%, 64%, and 49%, respectively. The 1- and 2-year LC rates were 100% and 83% for SRS alone and 90% and 80% for postoperative adjuvant SRS, respectively. Rates of OS were 90%, 84%, and 51% at 1, 2, and 5 years, respectively. Univariate analysis showed that multifractionated SRS was associated with superior LC (HR 0.26, 95% CI 0.10\u20130.71; p = 0.008); however, no significant difference in LC was observed when accounting for the biologically effective dose. Among patients presenting with neurological deficits, complete or partial resolution occurred for 8 of 20 tumors (40%). In symptomatic patients, pain was fully or partially alleviated for 27 of 36 tumors (75%). Six adverse radiation events (14%) were observed following treatment, including vertebral compression fracture (n = 2, 5%), pharyngoesophageal toxicity (n = 1, 2%), and transient peripheral neuropathy (n = 1, 2%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This series is among the largest to date evaluating outcomes of SRS for spinal and sacral chordomas, demonstrating durable LC and symptom relief with acceptable rates of toxicity when used alone and as an adjunct to surgery. SRS is also an effective treatment option for patients with recurrent disease who seek noninvasive treatment or are not candidates for resection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.focus24935","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:39:37Z","timestamp":1746081577000},"page":"E17","source":"Crossref","is-referenced-by-count":6,"title":["Management for chordoma of the spine and sacrum with stereotactic radiosurgery"],"prefix":"10.3171","volume":"58","author":[{"given":"Samuel","family":"Adida","sequence":"first","affiliation":[{"name":"School of Medicine, University of Pittsburgh;"},{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchet","family":"Taori","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Pittsburgh;"},{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta K.","family":"Sefcik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"Burton","sequence":"additional","affiliation":[{"name":"Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Gerszten","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2 suppl","key":"b1","series-title":"Neurosurgery","first-page":"A44","article-title":"Treatment of chordomas with CyberKnife: Georgetown University experience and treatment recommendations","volume":"64","author":"Henderson FC","year":"2009","unstructured":"Henderson FC, McCool K, Seigle J, Jean W, Harter W, Gagnon GJ. Treatment of chordomas with CyberKnife: Georgetown University experience and treatment recommendations. Neurosurgery. 2009;64(2 suppl):A44\u2013A53."},{"issue":"5","key":"b2","series-title":"J Clin Med","first-page":"1054","article-title":"Chordoma\u2013current understanding and modern treatment paradigms","volume":"10","author":"Barber SM","year":"2021","unstructured":"Barber SM, Sadrameli SS, Lee JJ,  Chordoma\u2013current understanding and modern treatment paradigms. J Clin Med. 2021;10(5):1054."},{"issue":"3","key":"b3","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience","volume":"21","author":"Molina CA","year":"2014","unstructured":"Molina CA, Ames CP, Chou D,  Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience. J Neurosurg Spine. 2014;21(3):348\u2013356."},{"issue":"6","key":"b4","series-title":"Ann Oncol","first-page":"1230","article-title":"Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group","volume":"28","author":"Stacchiotti S","year":"2017","unstructured":"Stacchiotti S, Gronchi A, Fossati P,  Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group. Ann Oncol. 2017;28(6):1230\u20131242."},{"issue":"2","key":"b5","series-title":"Spinal Cord","first-page":"166","article-title":"Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients","volume":"48","author":"Chen KW","year":"2010","unstructured":"Chen KW, Yang HL, Lu J, Liu JY, Chen XQ. Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients. Spinal Cord. 2010;48(2):166\u2013171."},{"issue":"4","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"493","article-title":"Chordoma of the mobile spine: fifty years of experience","volume":"31","author":"Boriani S","year":"2006","unstructured":"Boriani S, Bandiera S, Biagini R,  Chordoma of the mobile spine: fifty years of experience. Spine (Phila Pa 1976). 2006;31(4):493\u2013503."},{"issue":"20 Suppl","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"S186","article-title":"Safety and local control of radiation therapy for chordoma of the spine and sacrum: a systematic review","volume":"41","author":"Pennicooke B","year":"2016","unstructured":"Pennicooke B, Laufer I, Sahgal A,  Safety and local control of radiation therapy for chordoma of the spine and sacrum: a systematic review. Spine (Phila Pa 1976). 2016;41(20 Suppl):S186-S192."},{"issue":"1","key":"b8","series-title":"J Neurosurg Spine","first-page":"79","article-title":"Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum","volume":"32","author":"Jin CJ","year":"2019","unstructured":"Jin CJ, Berry-Candelario J, Reiner AS,  Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum. J Neurosurg Spine. 2019;32(1):79\u201388."},{"issue":"2","key":"b9","series-title":"J Neurooncol","first-page":"377","article-title":"Management of chordoma and chondrosarcoma with definitive dose-escalated single-fraction spine stereotactic radiosurgery","volume":"164","author":"Sherry AD","year":"2023","unstructured":"Sherry AD, Maroongroge S, De B,  Management of chordoma and chondrosarcoma with definitive dose-escalated single-fraction spine stereotactic radiosurgery. J Neurooncol. 2023;164(2):377\u2013386."},{"issue":"3","key":"b10","series-title":"Exp Ther Med","first-page":"2171","article-title":"Radioresistance of chordoma cells is associated with the ATM\/ATR pathway, in which RAD51 serves as an important downstream effector","volume":"14","author":"Zhang C","year":"2017","unstructured":"Zhang C, Wang B, Li L, Li Y, Li P, Lv G. Radioresistance of chordoma cells is associated with the ATM\/ATR pathway, in which RAD51 serves as an important downstream effector. Exp Ther Med. 2017;14(3):2171\u20132179."},{"issue":"3","key":"b11","series-title":"Neurosurgery","first-page":"494","article-title":"Outcomes after definitive surgery for spinal and sacral chordoma in 101 patients over 20 years","volume":"96","author":"Xia Y","year":"2025","unstructured":"Xia Y, Papali P, Al-Mistarehi AH,  Outcomes after definitive surgery for spinal and sacral chordoma in 101 patients over 20 years. Neurosurgery. 2025;96(3):494\u2013504."},{"issue":"6","key":"b12","series-title":"JAMA Oncol","first-page":"800","article-title":"Stereotactic radiosurgery vs conventional radiotherapy for localized vertebral metastases of the spine: phase 3 results of NRG Oncology\/RTOG 0631 Randomized Clinical Trial","volume":"9","author":"Ryu S","year":"2023","unstructured":"Ryu S, Deshmukh S, Timmerman RD,  Stereotactic radiosurgery vs conventional radiotherapy for localized vertebral metastases of the spine: phase 3 results of NRG Oncology\/RTOG 0631 Randomized Clinical Trial. JAMA Oncol. 2023;9(6):800\u2013807."},{"issue":"4","key":"b13","series-title":"Neurosurgery","first-page":"887","article-title":"Radiosurgery for benign intradural spinal tumors","volume":"62","author":"Gerszten PC","year":"2008","unstructured":"Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE. Radiosurgery for benign intradural spinal tumors. Neurosurgery. 2008;62(4):887\u2013896."},{"key":"b14","series-title":"Neurosurgery","article-title":"Spine stereotactic radiosurgery provides long-term local control and overall survival for benign intradural tumors","author":"Taori S","unstructured":"Taori S, Adida S, Kann MR,  Spine stereotactic radiosurgery provides long-term local control and overall survival for benign intradural tumors. Neurosurgery. Published online October 11, 2024. doi:10.1227\/neu.0000000000003219"},{"issue":"2","key":"b15","series-title":"Int J Radiat Oncol Biol Phys","first-page":"484","article-title":"High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions","volume":"71","author":"Yamada Y","year":"2008","unstructured":"Yamada Y, Bilsky MH, Lovelock DM,  High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys. 2008;71(2):484\u2013490."},{"issue":"4","key":"b16","series-title":"Neurosurgery","first-page":"673","article-title":"Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum","volume":"73","author":"Yamada Y","year":"2013","unstructured":"Yamada Y, Laufer I, Cox BW,  Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum. Neurosurgery. 2013;73(4):673\u2013680."},{"issue":"3","key":"b17","series-title":"Technol Cancer Res Treat","first-page":"302","article-title":"Single-fraction spine stereotactic body radiation therapy for the treatment of chordoma","volume":"16","author":"Jung EW","year":"2017","unstructured":"Jung EW, Jung DL, Balagamwala EH,  Single-fraction spine stereotactic body radiation therapy for the treatment of chordoma. Technol Cancer Res Treat. 2017;16(3):302\u2013309."},{"issue":"6","key":"b18","series-title":"Neurol Res","first-page":"597","article-title":"Stereotactic radiosurgery for primary malignant spinal tumors","volume":"36","author":"Chang UK","year":"2014","unstructured":"Chang UK, Lee DH, Kim MS. Stereotactic radiosurgery for primary malignant spinal tumors. Neurol Res. 2014;36(6):597\u2013606."},{"key":"b19","series-title":"Front Surg","first-page":"35","article-title":"Management of chordoma and chondrosarcoma with fractionated stereotactic radiotherapy","volume":"4","author":"Vasudevan HN","year":"2017","unstructured":"Vasudevan HN, Raleigh DR, Johnson J,  Management of chordoma and chondrosarcoma with fractionated stereotactic radiotherapy. Front Surg. 2017;4:35."},{"issue":"1","key":"b20","series-title":"Rep Pract Oncol Radiother","first-page":"74","article-title":"Adjuvant gamma knife surgery and image-guided, intensity-modulated radiation therapy for the treatment of sacral chordomas","volume":"24","author":"Lu S","year":"2019","unstructured":"Lu S, Peng X, Zou B, Zhou C, Feng M, Lang J. Adjuvant gamma knife surgery and image-guided, intensity-modulated radiation therapy for the treatment of sacral chordomas. Rep Pract Oncol Radiother. 2019;24(1):74\u201379."},{"issue":"1","key":"b21","series-title":"Eur Spine J","first-page":"244","article-title":"Results of salvage treatment with CyberKnife\u00ae fractioned radiosurgery in recurrent large chordoma","volume":"32","author":"Berber T","year":"2023","unstructured":"Berber T, Numano\u011flu \u00c7, Uysal E, Din\u00e7er S, Y\u0131ld\u0131r\u0131m BA. Results of salvage treatment with CyberKnife\u00ae fractioned radiosurgery in recurrent large chordoma. Eur Spine J. 2023;32(1):244\u2013253."},{"issue":"8","key":"b22","series-title":"J Clin Neurosci","first-page":"1101","article-title":"Management of intracranial and extracranial chordomas with CyberKnife stereotactic radiosurgery","volume":"19","author":"Jiang B","year":"2012","unstructured":"Jiang B, Veeravagu A, Lee M,  Management of intracranial and extracranial chordomas with CyberKnife stereotactic radiosurgery. J Clin Neurosci. 2012;19(8):1101\u20131106."},{"issue":"1","key":"b23","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment","volume":"42","author":"Lockney DT","year":"2017","unstructured":"Lockney DT, Shub T, Hopkins B,  Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment. Neurosurg Focus. 2017;42(1):E4."},{"issue":"5","key":"b24","series-title":"J Neurosurg Spine","first-page":"674","article-title":"High-dose hypofractionated stereotactic body radiotherapy for spinal chordoma","volume":"35","author":"Chen X","year":"2021","unstructured":"Chen X, Lo SL, Bettegowda C,  High-dose hypofractionated stereotactic body radiotherapy for spinal chordoma. J Neurosurg Spine. 2021;35(5):674\u2013683."},{"issue":"2","key":"b25","series-title":"Spine (Phila Pa 1976)","first-page":"193","article-title":"Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution","volume":"32","author":"Gerszten PC","year":"2007","unstructured":"Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976). 2007;32(2):193\u2013199."},{"issue":"3","key":"b26","series-title":"Int J Radiat Oncol Biol Phys","first-page":"602","article-title":"Long-term outcomes after stereotactic radiosurgery for spine metastases: radiation dose-response for late toxicity","volume":"101","author":"Ling DC","year":"2018","unstructured":"Ling DC, Flickinger JC, Burton SA,  Long-term outcomes after stereotactic radiosurgery for spine metastases: radiation dose-response for late toxicity. Int J Radiat Oncol Biol Phys. 2018;101(3):602\u2013609."},{"issue":"16","key":"b27","series-title":"Lancet Oncol","first-page":"e595","article-title":"Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro-Oncology (SPINO) group","volume":"16","author":"Thibault I","year":"2015","unstructured":"Thibault I, Chang EL, Sheehan J,  Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro-Oncology (SPINO) group. Lancet Oncol. 2015;16(16):e595\u2013e603."},{"issue":"2","key":"b28","series-title":"J Neurooncol","first-page":"257","article-title":"The role of spine stereotactic radiosurgery for patients with breast cancer metastases","volume":"167","author":"Taori S","year":"2024","unstructured":"Taori S, Adida S, Tang A,  The role of spine stereotactic radiosurgery for patients with breast cancer metastases. J Neurooncol. 2024;167(2):257\u2013266."},{"issue":"3","key":"b29","series-title":"J Neurooncol","first-page":"631","article-title":"Stereotactic radiosurgery for patients with spinal metastases from prostate cancer","volume":"170","author":"Adida S","year":"2024","unstructured":"Adida S, Taori S, Donohue JK,  Stereotactic radiosurgery for patients with spinal metastases from prostate cancer. J Neurooncol. 2024;170(3):631\u2013639."},{"issue":"4","key":"b30","series-title":"Neurosurgery","first-page":"860","article-title":"Safety and efficacy of balloon-assisted kyphoplasty followed by stereotactic body radiation therapy for pathological fractures","volume":"96","author":"Adida S","year":"2025","unstructured":"Adida S, Kann MR, Taori S,  Safety and efficacy of balloon-assisted kyphoplasty followed by stereotactic body radiation therapy for pathological fractures. Neurosurgery. 2025;96(4):860\u2013869."},{"key":"b31","series-title":"World Neurosurg","first-page":"e653","article-title":"Stereotactic radiosurgery for patients with spinal metastases from thyroid cancer: a 20-year experience","volume":"185","author":"Taori S","year":"2024","unstructured":"Taori S, Adida S, Tang A,  Stereotactic radiosurgery for patients with spinal metastases from thyroid cancer: a 20-year experience. World Neurosurg. 2024;185:e653\u2013e661."},{"issue":"2","key":"b32","series-title":"J Neurooncol","first-page":"299","article-title":"A case series and review of stereotactic body radiation therapy for contiguous multilevel spine metastases","volume":"171","author":"Adida S","year":"2025","unstructured":"Adida S, Taori S, Bhatia S,  A case series and review of stereotactic body radiation therapy for contiguous multilevel spine metastases. J Neurooncol. 2025;171(2):299\u2013309."},{"issue":"9","key":"b33","series-title":"Cancer","first-page":"2122","article-title":"Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients","volume":"88","author":"Bergh P","year":"2000","unstructured":"Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 2000;88(9):2122\u20132134."},{"issue":"11","key":"b34","series-title":"Cancer","first-page":"2574","article-title":"Clinicopathologic study of sacrococcygeal chordoma","volume":"53","author":"Kaiser TE","year":"1984","unstructured":"Kaiser TE, Pritchard DJ, Unni KK. Clinicopathologic study of sacrococcygeal chordoma. Cancer. 1984;53(11):2574\u20132578."},{"issue":"11","key":"b35","series-title":"Clin Orthop Relat Res","first-page":"2939","article-title":"Surgical margins and local control in resection of sacral chordomas","volume":"468","author":"Ruggieri P","year":"2010","unstructured":"Ruggieri P, Angelini A, Ussia G, Montalti M, Mercuri M. Surgical margins and local control in resection of sacral chordomas. Clin Orthop Relat Res. 2010;468(11):2939\u20132947."},{"issue":"4","key":"b36","series-title":"Spine (Phila Pa 1976)","first-page":"384","article-title":"An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group","volume":"34","author":"Chan P","year":"2009","unstructured":"Chan P, Boriani S, Fourney DR,  An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group. Spine (Phila Pa 1976). 2009;34(4):384\u2013391."},{"issue":"4","key":"b37","series-title":"J Neurosurg Spine","first-page":"644","article-title":"Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database","volume":"24","author":"Gokaslan ZL","year":"2016","unstructured":"Gokaslan ZL, Zadnik PL, Sciubba DM,  Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine. 2016;24(4):644\u2013651."},{"issue":"2","key":"b38","series-title":"J Neurosurg Spine","first-page":"106","article-title":"Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy","volume":"3","author":"Guo Y","year":"2005","unstructured":"Guo Y, Palmer JL, Shen L,  Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy. J Neurosurg Spine. 2005;3(2):106\u2013110."},{"issue":"6","key":"b39","series-title":"J Neurosurg Spine","first-page":"788","article-title":"High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors","volume":"23","author":"Rotondo RL","year":"2015","unstructured":"Rotondo RL, Folkert W, Liebsch NJ,  High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors. J Neurosurg Spine. 2015;23(6):788\u2013797."},{"issue":"1","key":"b40","series-title":"Ann Surg Oncol","first-page":"211","article-title":"Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers","volume":"17","author":"Stacchiotti S","year":"2010","unstructured":"Stacchiotti S, Casali PG, Lo Vullo S,  Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers. Ann Surg Oncol. 2010;17(1):211\u2013219."},{"key":"b41","series-title":"Radiat Oncol","first-page":"116","article-title":"In vitro characterization of cells derived from chordoma cell line U-CH1 following treatment with X-rays, heavy ions and chemotherapeutic drugs","volume":"6","author":"Kato TA","year":"2011","unstructured":"Kato TA, Tsuda A, Uesaka M,  In vitro characterization of cells derived from chordoma cell line U-CH1 following treatment with X-rays, heavy ions and chemotherapeutic drugs. Radiat Oncol. 2011;6:116."},{"issue":"2","key":"b42","series-title":"Cell Rep","first-page":"495","article-title":"Brachyury-YAP regulatory axis drives stemness and growth in cancer","volume":"21","author":"Shah SR","year":"2017","unstructured":"Shah SR, David JM, Tippens ND,  Brachyury-YAP regulatory axis drives stemness and growth in cancer. Cell Rep. 2017;21(2):495\u2013507."},{"issue":"1","key":"b43","series-title":"Spine J","first-page":"34","article-title":"The impact of radiotherapy on survival after surgical resection of chordoma with minimum five-year follow-up","volume":"23","author":"Tobert DG","year":"2023","unstructured":"Tobert DG, Kelly SP, Xiong GX,  The impact of radiotherapy on survival after surgical resection of chordoma with minimum five-year follow-up. Spine J. 2023;23(1):34\u201341."},{"issue":"9","key":"b44","series-title":"J Clin Neurosci","first-page":"1490","article-title":"Outcomes and patterns of care in adult skull base chordomas from the Surveillance, Epidemiology, and End Results (SEER) database","volume":"21","author":"Jones PS","year":"2014","unstructured":"Jones PS, Aghi MK, Muzikansky A, Shih HA, Barker FG II, Curry WT Jr. Outcomes and patterns of care in adult skull base chordomas from the Surveillance, Epidemiology, and End Results (SEER) database. J Clin Neurosci. 2014;21(9):1490\u20131496."},{"issue":"2","key":"b45","series-title":"Lancet Oncol","first-page":"e71","article-title":"Building a global consensus approach to chordoma: a position paper from the medical and patient community","volume":"16","author":"Stacchiotti S","year":"2015","unstructured":"Stacchiotti S, Sommer J. Building a global consensus approach to chordoma: a position paper from the medical and patient community. Lancet Oncol. 2015;16(2):e71\u2013e83."},{"issue":"5","key":"b46","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Proton versus photon adjuvant radiotherapy: a multicenter comparative evaluation of recurrence following spinal chordoma resection","volume":"56","author":"Ghaith AK","year":"2024","unstructured":"Ghaith AK, Nguyen R, El-Hajj VG,  Proton versus photon adjuvant radiotherapy: a multicenter comparative evaluation of recurrence following spinal chordoma resection. Neurosurg Focus. 2024;56(5):E9."},{"issue":"5","key":"b47","series-title":"Adv Radiat Oncol","first-page":"101456","article-title":"A prospective phase I\/II clinical trial of high-dose proton therapy for chordomas and chondrosarcomas","volume":"9","author":"Dastgheyb SS","year":"2024","unstructured":"Dastgheyb SS, Dreyfuss AD, LaRiviere MJ,  A prospective phase I\/II clinical trial of high-dose proton therapy for chordomas and chondrosarcomas. Adv Radiat Oncol. 2024;9(5):101456."},{"issue":"1","key":"b48","series-title":"JAMA Netw Open","first-page":"e2141927","article-title":"Comparison of oncologic outcomes and treatment-related toxicity of carbon ion radiotherapy and en bloc resection for sacral chordoma","volume":"5","author":"Yolcu YU","year":"2022","unstructured":"Yolcu YU, Zreik J, Wahood W,  Comparison of oncologic outcomes and treatment-related toxicity of carbon ion radiotherapy and en bloc resection for sacral chordoma. JAMA Netw Open. 2022;5(1):e2141927."},{"issue":"2","key":"b49","series-title":"Rep Pract Oncol Radiother","first-page":"207","article-title":"Intensity-modulated radiotherapy for the management of primary and recurrent chordomas: a retrospective long-term follow-up study","volume":"28","author":"Wolf RJ","year":"2023","unstructured":"Wolf RJ, Winkler V, Mattke M, Uhl M, Debus J. Intensity-modulated radiotherapy for the management of primary and recurrent chordomas: a retrospective long-term follow-up study. Rep Pract Oncol Radiother. 2023;28(2):207\u2013216."},{"issue":"4","key":"b50","series-title":"Int J Radiat Oncol Biol Phys","first-page":"972","article-title":"Outcomes of patients with primary sacral chordoma treated with definitive proton beam therapy","volume":"100","author":"Aibe N","year":"2018","unstructured":"Aibe N, Demizu Y, Sulaiman NS,  Outcomes of patients with primary sacral chordoma treated with definitive proton beam therapy. Int J Radiat Oncol Biol Phys. 2018;100(4):972\u2013979."},{"issue":"1","key":"b51","series-title":"Int J Radiat Oncol Biol Phys","first-page":"322","article-title":"Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases","volume":"95","author":"Imai R","year":"2016","unstructured":"Imai R, Kamada T, Araki N. Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases. Int J Radiat Oncol Biol Phys. 2016;95(1):322\u2013327."},{"issue":"2","key":"b52","series-title":"Int J Radiat Oncol Biol Phys","first-page":"254","article-title":"Updated outcome and analysis of tumor response in mobile spine and sacral chordoma treated with definitive high-dose photon\/proton radiation therapy","volume":"97","author":"Kabolizadeh P","year":"2017","unstructured":"Kabolizadeh P, Chen YL, Liebsch N,  Updated outcome and analysis of tumor response in mobile spine and sacral chordoma treated with definitive high-dose photon\/proton radiation therapy. Int J Radiat Oncol Biol Phys. 2017;97(2):254\u2013262."},{"issue":"5","key":"b53","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum","volume":"50","author":"Pennington Z","year":"2021","unstructured":"Pennington Z, Ehresman J, Elsamadicy AA,  Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum. Neurosurg Focus. 2021;50(5):E17."},{"key":"b54","series-title":"Radiat Oncol","first-page":"100","article-title":"Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma\u2014the ISAC trial protocol","volume":"9","author":"Uhl M","year":"2014","unstructured":"Uhl M, Edler L, Jensen AD,  Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma\u2014the ISAC trial protocol. Radiat Oncol. 2014;9:100."},{"issue":"1","key":"b55","series-title":"BMC Cancer","first-page":"575","article-title":"A randomized controlled phase III study comparing hadrontherapy with carbon ions versus conventional radiotherapy - including photon and proton therapy - for the treatment of radioresistant tumors: the ETOILE trial","volume":"22","author":"Balosso J","year":"2022","unstructured":"Balosso J, Febvey-Combes O, Iung A,  A randomized controlled phase III study comparing hadrontherapy with carbon ions versus conventional radiotherapy - including photon and proton therapy - for the treatment of radioresistant tumors: the ETOILE trial. BMC Cancer. 2022;22(1):575."},{"issue":"6","key":"b56","series-title":"Cancers (Basel)","first-page":"1660","article-title":"Pragmatic, prospective comparative effectiveness trial of carbon ion therapy, surgery, and proton therapy for the management of pelvic sarcomas (soft tissue\/bone) involving the bone: the PROSPER study rationale and design","volume":"15","author":"Hoppe BS","year":"2023","unstructured":"Hoppe BS, Petersen IA, Wilke BK,  Pragmatic, prospective comparative effectiveness trial of carbon ion therapy, surgery, and proton therapy for the management of pelvic sarcomas (soft tissue\/bone) involving the bone: the PROSPER study rationale and design. Cancers (Basel). 2023;15(6):1660."},{"issue":"5","key":"b57","series-title":"Neurosurg Focus","first-page":"E15","article-title":"The role of systemic therapy in advanced skull base chordomas: overview of the current state and the MD Anderson protocol","volume":"56","author":"Banu MA","year":"2024","unstructured":"Banu MA, Raza SM, Amini M,  The role of systemic therapy in advanced skull base chordomas: overview of the current state and the MD Anderson protocol. Neurosurg Focus. 2024;56(5):E15."},{"issue":"24","key":"b58","series-title":"Cancers (Basel)","first-page":"5800","article-title":"Chordoma: a comprehensive systematic review of clinical trials","volume":"15","author":"Chen S","year":"2023","unstructured":"Chen S, Ulloa R, Soffer J,  Chordoma: a comprehensive systematic review of clinical trials. Cancers (Basel). 2023;15(24):5800."},{"key":"b59","series-title":"Front Oncol","first-page":"30","article-title":"Molecular targeted therapy in the treatment of chordoma: a systematic review","volume":"9","author":"Meng T","year":"2019","unstructured":"Meng T, Jin J, Jiang C,  Molecular targeted therapy in the treatment of chordoma: a systematic review. Front Oncol. 2019;9:30."},{"issue":"2 suppl","key":"b1","series-title":"Neurosurgery","first-page":"A44","article-title":"Treatment of chordomas with CyberKnife: Georgetown University experience and treatment recommendations","volume":"64","author":"Henderson FC","year":"2009","unstructured":"Henderson FC, McCool K, Seigle J, Jean W, Harter W, Gagnon GJ. Treatment of chordomas with CyberKnife: Georgetown University experience and treatment recommendations. Neurosurgery. 2009;64(2 suppl):A44\u2013A53."},{"issue":"5","key":"b2","series-title":"J Clin Med","first-page":"1054","article-title":"Chordoma\u2013current understanding and modern treatment paradigms","volume":"10","author":"Barber SM","year":"2021","unstructured":"Barber SM, Sadrameli SS, Lee JJ,  Chordoma\u2013current understanding and modern treatment paradigms. J Clin Med. 2021;10(5):1054."},{"issue":"3","key":"b3","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience","volume":"21","author":"Molina CA","year":"2014","unstructured":"Molina CA, Ames CP, Chou D,  Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience. J Neurosurg Spine. 2014;21(3):348\u2013356."},{"issue":"6","key":"b4","series-title":"Ann Oncol","first-page":"1230","article-title":"Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group","volume":"28","author":"Stacchiotti S","year":"2017","unstructured":"Stacchiotti S, Gronchi A, Fossati P,  Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group. Ann Oncol. 2017;28(6):1230\u20131242."},{"issue":"2","key":"b5","series-title":"Spinal Cord","first-page":"166","article-title":"Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients","volume":"48","author":"Chen KW","year":"2010","unstructured":"Chen KW, Yang HL, Lu J, Liu JY, Chen XQ. Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients. Spinal Cord. 2010;48(2):166\u2013171."},{"issue":"4","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"493","article-title":"Chordoma of the mobile spine: fifty years of experience","volume":"31","author":"Boriani S","year":"2006","unstructured":"Boriani S, Bandiera S, Biagini R,  Chordoma of the mobile spine: fifty years of experience. Spine (Phila Pa 1976). 2006;31(4):493\u2013503."},{"issue":"20 Suppl","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"S186","article-title":"Safety and local control of radiation therapy for chordoma of the spine and sacrum: a systematic review","volume":"41","author":"Pennicooke B","year":"2016","unstructured":"Pennicooke B, Laufer I, Sahgal A,  Safety and local control of radiation therapy for chordoma of the spine and sacrum: a systematic review. Spine (Phila Pa 1976). 2016;41(20 Suppl):S186-S192."},{"issue":"1","key":"b8","series-title":"J Neurosurg Spine","first-page":"79","article-title":"Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum","volume":"32","author":"Jin CJ","year":"2019","unstructured":"Jin CJ, Berry-Candelario J, Reiner AS,  Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum. J Neurosurg Spine. 2019;32(1):79\u201388."},{"issue":"2","key":"b9","series-title":"J Neurooncol","first-page":"377","article-title":"Management of chordoma and chondrosarcoma with definitive dose-escalated single-fraction spine stereotactic radiosurgery","volume":"164","author":"Sherry AD","year":"2023","unstructured":"Sherry AD, Maroongroge S, De B,  Management of chordoma and chondrosarcoma with definitive dose-escalated single-fraction spine stereotactic radiosurgery. J Neurooncol. 2023;164(2):377\u2013386."},{"issue":"3","key":"b10","series-title":"Exp Ther Med","first-page":"2171","article-title":"Radioresistance of chordoma cells is associated with the ATM\/ATR pathway, in which RAD51 serves as an important downstream effector","volume":"14","author":"Zhang C","year":"2017","unstructured":"Zhang C, Wang B, Li L, Li Y, Li P, Lv G. Radioresistance of chordoma cells is associated with the ATM\/ATR pathway, in which RAD51 serves as an important downstream effector. Exp Ther Med. 2017;14(3):2171\u20132179."},{"issue":"3","key":"b11","series-title":"Neurosurgery","first-page":"494","article-title":"Outcomes after definitive surgery for spinal and sacral chordoma in 101 patients over 20 years","volume":"96","author":"Xia Y","year":"2025","unstructured":"Xia Y, Papali P, Al-Mistarehi AH,  Outcomes after definitive surgery for spinal and sacral chordoma in 101 patients over 20 years. Neurosurgery. 2025;96(3):494\u2013504."},{"issue":"6","key":"b12","series-title":"JAMA Oncol","first-page":"800","article-title":"Stereotactic radiosurgery vs conventional radiotherapy for localized vertebral metastases of the spine: phase 3 results of NRG Oncology\/RTOG 0631 Randomized Clinical Trial","volume":"9","author":"Ryu S","year":"2023","unstructured":"Ryu S, Deshmukh S, Timmerman RD,  Stereotactic radiosurgery vs conventional radiotherapy for localized vertebral metastases of the spine: phase 3 results of NRG Oncology\/RTOG 0631 Randomized Clinical Trial. JAMA Oncol. 2023;9(6):800\u2013807."},{"issue":"4","key":"b13","series-title":"Neurosurgery","first-page":"887","article-title":"Radiosurgery for benign intradural spinal tumors","volume":"62","author":"Gerszten PC","year":"2008","unstructured":"Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE. Radiosurgery for benign intradural spinal tumors. Neurosurgery. 2008;62(4):887\u2013896."},{"key":"b14","series-title":"Neurosurgery","article-title":"Spine stereotactic radiosurgery provides long-term local control and overall survival for benign intradural tumors","author":"Taori S","unstructured":"Taori S, Adida S, Kann MR,  Spine stereotactic radiosurgery provides long-term local control and overall survival for benign intradural tumors. Neurosurgery. Published online October 11, 2024. doi:10.1227\/neu.0000000000003219"},{"issue":"2","key":"b15","series-title":"Int J Radiat Oncol Biol Phys","first-page":"484","article-title":"High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions","volume":"71","author":"Yamada Y","year":"2008","unstructured":"Yamada Y, Bilsky MH, Lovelock DM,  High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys. 2008;71(2):484\u2013490."},{"issue":"4","key":"b16","series-title":"Neurosurgery","first-page":"673","article-title":"Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum","volume":"73","author":"Yamada Y","year":"2013","unstructured":"Yamada Y, Laufer I, Cox BW,  Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum. Neurosurgery. 2013;73(4):673\u2013680."},{"issue":"3","key":"b17","series-title":"Technol Cancer Res Treat","first-page":"302","article-title":"Single-fraction spine stereotactic body radiation therapy for the treatment of chordoma","volume":"16","author":"Jung EW","year":"2017","unstructured":"Jung EW, Jung DL, Balagamwala EH,  Single-fraction spine stereotactic body radiation therapy for the treatment of chordoma. Technol Cancer Res Treat. 2017;16(3):302\u2013309."},{"issue":"6","key":"b18","series-title":"Neurol Res","first-page":"597","article-title":"Stereotactic radiosurgery for primary malignant spinal tumors","volume":"36","author":"Chang UK","year":"2014","unstructured":"Chang UK, Lee DH, Kim MS. Stereotactic radiosurgery for primary malignant spinal tumors. Neurol Res. 2014;36(6):597\u2013606."},{"key":"b19","series-title":"Front Surg","first-page":"35","article-title":"Management of chordoma and chondrosarcoma with fractionated stereotactic radiotherapy","volume":"4","author":"Vasudevan HN","year":"2017","unstructured":"Vasudevan HN, Raleigh DR, Johnson J,  Management of chordoma and chondrosarcoma with fractionated stereotactic radiotherapy. Front Surg. 2017;4:35."},{"issue":"1","key":"b20","series-title":"Rep Pract Oncol Radiother","first-page":"74","article-title":"Adjuvant gamma knife surgery and image-guided, intensity-modulated radiation therapy for the treatment of sacral chordomas","volume":"24","author":"Lu S","year":"2019","unstructured":"Lu S, Peng X, Zou B, Zhou C, Feng M, Lang J. Adjuvant gamma knife surgery and image-guided, intensity-modulated radiation therapy for the treatment of sacral chordomas. Rep Pract Oncol Radiother. 2019;24(1):74\u201379."},{"issue":"1","key":"b21","series-title":"Eur Spine J","first-page":"244","article-title":"Results of salvage treatment with CyberKnife\u00ae fractioned radiosurgery in recurrent large chordoma","volume":"32","author":"Berber T","year":"2023","unstructured":"Berber T, Numano\u011flu \u00c7, Uysal E, Din\u00e7er S, Y\u0131ld\u0131r\u0131m BA. Results of salvage treatment with CyberKnife\u00ae fractioned radiosurgery in recurrent large chordoma. Eur Spine J. 2023;32(1):244\u2013253."},{"issue":"8","key":"b22","series-title":"J Clin Neurosci","first-page":"1101","article-title":"Management of intracranial and extracranial chordomas with CyberKnife stereotactic radiosurgery","volume":"19","author":"Jiang B","year":"2012","unstructured":"Jiang B, Veeravagu A, Lee M,  Management of intracranial and extracranial chordomas with CyberKnife stereotactic radiosurgery. J Clin Neurosci. 2012;19(8):1101\u20131106."},{"issue":"1","key":"b23","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment","volume":"42","author":"Lockney DT","year":"2017","unstructured":"Lockney DT, Shub T, Hopkins B,  Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment. Neurosurg Focus. 2017;42(1):E4."},{"issue":"5","key":"b24","series-title":"J Neurosurg Spine","first-page":"674","article-title":"High-dose hypofractionated stereotactic body radiotherapy for spinal chordoma","volume":"35","author":"Chen X","year":"2021","unstructured":"Chen X, Lo SL, Bettegowda C,  High-dose hypofractionated stereotactic body radiotherapy for spinal chordoma. J Neurosurg Spine. 2021;35(5):674\u2013683."},{"issue":"2","key":"b25","series-title":"Spine (Phila Pa 1976)","first-page":"193","article-title":"Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution","volume":"32","author":"Gerszten PC","year":"2007","unstructured":"Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976). 2007;32(2):193\u2013199."},{"issue":"3","key":"b26","series-title":"Int J Radiat Oncol Biol Phys","first-page":"602","article-title":"Long-term outcomes after stereotactic radiosurgery for spine metastases: radiation dose-response for late toxicity","volume":"101","author":"Ling DC","year":"2018","unstructured":"Ling DC, Flickinger JC, Burton SA,  Long-term outcomes after stereotactic radiosurgery for spine metastases: radiation dose-response for late toxicity. Int J Radiat Oncol Biol Phys. 2018;101(3):602\u2013609."},{"issue":"16","key":"b27","series-title":"Lancet Oncol","first-page":"e595","article-title":"Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro-Oncology (SPINO) group","volume":"16","author":"Thibault I","year":"2015","unstructured":"Thibault I, Chang EL, Sheehan J,  Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro-Oncology (SPINO) group. Lancet Oncol. 2015;16(16):e595\u2013e603."},{"issue":"2","key":"b28","series-title":"J Neurooncol","first-page":"257","article-title":"The role of spine stereotactic radiosurgery for patients with breast cancer metastases","volume":"167","author":"Taori S","year":"2024","unstructured":"Taori S, Adida S, Tang A,  The role of spine stereotactic radiosurgery for patients with breast cancer metastases. J Neurooncol. 2024;167(2):257\u2013266."},{"issue":"3","key":"b29","series-title":"J Neurooncol","first-page":"631","article-title":"Stereotactic radiosurgery for patients with spinal metastases from prostate cancer","volume":"170","author":"Adida S","year":"2024","unstructured":"Adida S, Taori S, Donohue JK,  Stereotactic radiosurgery for patients with spinal metastases from prostate cancer. J Neurooncol. 2024;170(3):631\u2013639."},{"issue":"4","key":"b30","series-title":"Neurosurgery","first-page":"860","article-title":"Safety and efficacy of balloon-assisted kyphoplasty followed by stereotactic body radiation therapy for pathological fractures","volume":"96","author":"Adida S","year":"2025","unstructured":"Adida S, Kann MR, Taori S,  Safety and efficacy of balloon-assisted kyphoplasty followed by stereotactic body radiation therapy for pathological fractures. Neurosurgery. 2025;96(4):860\u2013869."},{"key":"b31","series-title":"World Neurosurg","first-page":"e653","article-title":"Stereotactic radiosurgery for patients with spinal metastases from thyroid cancer: a 20-year experience","volume":"185","author":"Taori S","year":"2024","unstructured":"Taori S, Adida S, Tang A,  Stereotactic radiosurgery for patients with spinal metastases from thyroid cancer: a 20-year experience. World Neurosurg. 2024;185:e653\u2013e661."},{"issue":"2","key":"b32","series-title":"J Neurooncol","first-page":"299","article-title":"A case series and review of stereotactic body radiation therapy for contiguous multilevel spine metastases","volume":"171","author":"Adida S","year":"2025","unstructured":"Adida S, Taori S, Bhatia S,  A case series and review of stereotactic body radiation therapy for contiguous multilevel spine metastases. J Neurooncol. 2025;171(2):299\u2013309."},{"issue":"9","key":"b33","series-title":"Cancer","first-page":"2122","article-title":"Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients","volume":"88","author":"Bergh P","year":"2000","unstructured":"Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 2000;88(9):2122\u20132134."},{"issue":"11","key":"b34","series-title":"Cancer","first-page":"2574","article-title":"Clinicopathologic study of sacrococcygeal chordoma","volume":"53","author":"Kaiser TE","year":"1984","unstructured":"Kaiser TE, Pritchard DJ, Unni KK. Clinicopathologic study of sacrococcygeal chordoma. Cancer. 1984;53(11):2574\u20132578."},{"issue":"11","key":"b35","series-title":"Clin Orthop Relat Res","first-page":"2939","article-title":"Surgical margins and local control in resection of sacral chordomas","volume":"468","author":"Ruggieri P","year":"2010","unstructured":"Ruggieri P, Angelini A, Ussia G, Montalti M, Mercuri M. Surgical margins and local control in resection of sacral chordomas. Clin Orthop Relat Res. 2010;468(11):2939\u20132947."},{"issue":"4","key":"b36","series-title":"Spine (Phila Pa 1976)","first-page":"384","article-title":"An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group","volume":"34","author":"Chan P","year":"2009","unstructured":"Chan P, Boriani S, Fourney DR,  An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group. Spine (Phila Pa 1976). 2009;34(4):384\u2013391."},{"issue":"4","key":"b37","series-title":"J Neurosurg Spine","first-page":"644","article-title":"Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database","volume":"24","author":"Gokaslan ZL","year":"2016","unstructured":"Gokaslan ZL, Zadnik PL, Sciubba DM,  Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine. 2016;24(4):644\u2013651."},{"issue":"2","key":"b38","series-title":"J Neurosurg Spine","first-page":"106","article-title":"Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy","volume":"3","author":"Guo Y","year":"2005","unstructured":"Guo Y, Palmer JL, Shen L,  Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy. J Neurosurg Spine. 2005;3(2):106\u2013110."},{"issue":"6","key":"b39","series-title":"J Neurosurg Spine","first-page":"788","article-title":"High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors","volume":"23","author":"Rotondo RL","year":"2015","unstructured":"Rotondo RL, Folkert W, Liebsch NJ,  High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors. J Neurosurg Spine. 2015;23(6):788\u2013797."},{"issue":"1","key":"b40","series-title":"Ann Surg Oncol","first-page":"211","article-title":"Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers","volume":"17","author":"Stacchiotti S","year":"2010","unstructured":"Stacchiotti S, Casali PG, Lo Vullo S,  Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers. Ann Surg Oncol. 2010;17(1):211\u2013219."},{"key":"b41","series-title":"Radiat Oncol","first-page":"116","article-title":"In vitro characterization of cells derived from chordoma cell line U-CH1 following treatment with X-rays, heavy ions and chemotherapeutic drugs","volume":"6","author":"Kato TA","year":"2011","unstructured":"Kato TA, Tsuda A, Uesaka M,  In vitro characterization of cells derived from chordoma cell line U-CH1 following treatment with X-rays, heavy ions and chemotherapeutic drugs. Radiat Oncol. 2011;6:116."},{"issue":"2","key":"b42","series-title":"Cell Rep","first-page":"495","article-title":"Brachyury-YAP regulatory axis drives stemness and growth in cancer","volume":"21","author":"Shah SR","year":"2017","unstructured":"Shah SR, David JM, Tippens ND,  Brachyury-YAP regulatory axis drives stemness and growth in cancer. Cell Rep. 2017;21(2):495\u2013507."},{"issue":"1","key":"b43","series-title":"Spine J","first-page":"34","article-title":"The impact of radiotherapy on survival after surgical resection of chordoma with minimum five-year follow-up","volume":"23","author":"Tobert DG","year":"2023","unstructured":"Tobert DG, Kelly SP, Xiong GX,  The impact of radiotherapy on survival after surgical resection of chordoma with minimum five-year follow-up. Spine J. 2023;23(1):34\u201341."},{"issue":"9","key":"b44","series-title":"J Clin Neurosci","first-page":"1490","article-title":"Outcomes and patterns of care in adult skull base chordomas from the Surveillance, Epidemiology, and End Results (SEER) database","volume":"21","author":"Jones PS","year":"2014","unstructured":"Jones PS, Aghi MK, Muzikansky A, Shih HA, Barker FG II, Curry WT Jr. Outcomes and patterns of care in adult skull base chordomas from the Surveillance, Epidemiology, and End Results (SEER) database. J Clin Neurosci. 2014;21(9):1490\u20131496."},{"issue":"2","key":"b45","series-title":"Lancet Oncol","first-page":"e71","article-title":"Building a global consensus approach to chordoma: a position paper from the medical and patient community","volume":"16","author":"Stacchiotti S","year":"2015","unstructured":"Stacchiotti S, Sommer J. Building a global consensus approach to chordoma: a position paper from the medical and patient community. Lancet Oncol. 2015;16(2):e71\u2013e83."},{"issue":"5","key":"b46","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Proton versus photon adjuvant radiotherapy: a multicenter comparative evaluation of recurrence following spinal chordoma resection","volume":"56","author":"Ghaith AK","year":"2024","unstructured":"Ghaith AK, Nguyen R, El-Hajj VG,  Proton versus photon adjuvant radiotherapy: a multicenter comparative evaluation of recurrence following spinal chordoma resection. Neurosurg Focus. 2024;56(5):E9."},{"issue":"5","key":"b47","series-title":"Adv Radiat Oncol","first-page":"101456","article-title":"A prospective phase I\/II clinical trial of high-dose proton therapy for chordomas and chondrosarcomas","volume":"9","author":"Dastgheyb SS","year":"2024","unstructured":"Dastgheyb SS, Dreyfuss AD, LaRiviere MJ,  A prospective phase I\/II clinical trial of high-dose proton therapy for chordomas and chondrosarcomas. Adv Radiat Oncol. 2024;9(5):101456."},{"issue":"1","key":"b48","series-title":"JAMA Netw Open","first-page":"e2141927","article-title":"Comparison of oncologic outcomes and treatment-related toxicity of carbon ion radiotherapy and en bloc resection for sacral chordoma","volume":"5","author":"Yolcu YU","year":"2022","unstructured":"Yolcu YU, Zreik J, Wahood W,  Comparison of oncologic outcomes and treatment-related toxicity of carbon ion radiotherapy and en bloc resection for sacral chordoma. JAMA Netw Open. 2022;5(1):e2141927."},{"issue":"2","key":"b49","series-title":"Rep Pract Oncol Radiother","first-page":"207","article-title":"Intensity-modulated radiotherapy for the management of primary and recurrent chordomas: a retrospective long-term follow-up study","volume":"28","author":"Wolf RJ","year":"2023","unstructured":"Wolf RJ, Winkler V, Mattke M, Uhl M, Debus J. Intensity-modulated radiotherapy for the management of primary and recurrent chordomas: a retrospective long-term follow-up study. Rep Pract Oncol Radiother. 2023;28(2):207\u2013216."},{"issue":"4","key":"b50","series-title":"Int J Radiat Oncol Biol Phys","first-page":"972","article-title":"Outcomes of patients with primary sacral chordoma treated with definitive proton beam therapy","volume":"100","author":"Aibe N","year":"2018","unstructured":"Aibe N, Demizu Y, Sulaiman NS,  Outcomes of patients with primary sacral chordoma treated with definitive proton beam therapy. Int J Radiat Oncol Biol Phys. 2018;100(4):972\u2013979."},{"issue":"1","key":"b51","series-title":"Int J Radiat Oncol Biol Phys","first-page":"322","article-title":"Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases","volume":"95","author":"Imai R","year":"2016","unstructured":"Imai R, Kamada T, Araki N. Carbon ion radiation therapy for unresectable sacral chordoma: an analysis of 188 cases. Int J Radiat Oncol Biol Phys. 2016;95(1):322\u2013327."},{"issue":"2","key":"b52","series-title":"Int J Radiat Oncol Biol Phys","first-page":"254","article-title":"Updated outcome and analysis of tumor response in mobile spine and sacral chordoma treated with definitive high-dose photon\/proton radiation therapy","volume":"97","author":"Kabolizadeh P","year":"2017","unstructured":"Kabolizadeh P, Chen YL, Liebsch N,  Updated outcome and analysis of tumor response in mobile spine and sacral chordoma treated with definitive high-dose photon\/proton radiation therapy. Int J Radiat Oncol Biol Phys. 2017;97(2):254\u2013262."},{"issue":"5","key":"b53","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum","volume":"50","author":"Pennington Z","year":"2021","unstructured":"Pennington Z, Ehresman J, Elsamadicy AA,  Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum. Neurosurg Focus. 2021;50(5):E17."},{"key":"b54","series-title":"Radiat Oncol","first-page":"100","article-title":"Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma\u2014the ISAC trial protocol","volume":"9","author":"Uhl M","year":"2014","unstructured":"Uhl M, Edler L, Jensen AD,  Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma\u2014the ISAC trial protocol. Radiat Oncol. 2014;9:100."},{"issue":"1","key":"b55","series-title":"BMC Cancer","first-page":"575","article-title":"A randomized controlled phase III study comparing hadrontherapy with carbon ions versus conventional radiotherapy - including photon and proton therapy - for the treatment of radioresistant tumors: the ETOILE trial","volume":"22","author":"Balosso J","year":"2022","unstructured":"Balosso J, Febvey-Combes O, Iung A,  A randomized controlled phase III study comparing hadrontherapy with carbon ions versus conventional radiotherapy - including photon and proton therapy - for the treatment of radioresistant tumors: the ETOILE trial. BMC Cancer. 2022;22(1):575."},{"issue":"6","key":"b56","series-title":"Cancers (Basel)","first-page":"1660","article-title":"Pragmatic, prospective comparative effectiveness trial of carbon ion therapy, surgery, and proton therapy for the management of pelvic sarcomas (soft tissue\/bone) involving the bone: the PROSPER study rationale and design","volume":"15","author":"Hoppe BS","year":"2023","unstructured":"Hoppe BS, Petersen IA, Wilke BK,  Pragmatic, prospective comparative effectiveness trial of carbon ion therapy, surgery, and proton therapy for the management of pelvic sarcomas (soft tissue\/bone) involving the bone: the PROSPER study rationale and design. Cancers (Basel). 2023;15(6):1660."},{"issue":"5","key":"b57","series-title":"Neurosurg Focus","first-page":"E15","article-title":"The role of systemic therapy in advanced skull base chordomas: overview of the current state and the MD Anderson protocol","volume":"56","author":"Banu MA","year":"2024","unstructured":"Banu MA, Raza SM, Amini M,  The role of systemic therapy in advanced skull base chordomas: overview of the current state and the MD Anderson protocol. Neurosurg Focus. 2024;56(5):E15."},{"issue":"24","key":"b58","series-title":"Cancers (Basel)","first-page":"5800","article-title":"Chordoma: a comprehensive systematic review of clinical trials","volume":"15","author":"Chen S","year":"2023","unstructured":"Chen S, Ulloa R, Soffer J,  Chordoma: a comprehensive systematic review of clinical trials. Cancers (Basel). 2023;15(24):5800."},{"key":"b59","series-title":"Front Oncol","first-page":"30","article-title":"Molecular targeted therapy in the treatment of chordoma: a systematic review","volume":"9","author":"Meng T","year":"2019","unstructured":"Meng T, Jin J, Jiang C,  Molecular targeted therapy in the treatment of chordoma: a systematic review. Front Oncol. 2019;9:30."}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/5\/article-pE17.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/5\/article-pE17.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/5\/article-pE17.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:24:53Z","timestamp":1780734293000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/5\/article-pE17.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":118,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2025.2.focus24935","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}