Spinal laser interstitial thermal therapy for treatment of chordoma: single-center experience and literature review.

purposeChordomas are rare, locally aggressive tumors for which effective salvage options are limited once maximal surgical and radiation therapy have been exhausted. Laser interstitial thermal therapy (LITT) is a minimally invasive, MRI-guided ablative technique established for spinal metastases, but published experience with LITT for chordoma remains limited to isolated case reports. We report the largest clinical experience with spinal LITT (sLITT) for chordoma and review the existing literature.

methodsWe performed a retrospective, IRB-approved single-institution case series of patients with histologically confirmed chordoma treated with sLITT. Clinical, operative, and radiographic data were abstracted, including tumor volumes, ablation parameters, and functional and oncologic outcomes. A systematic PubMed search was performed to identify all prior published reports of LITT for chordoma.

resultsFour patients underwent sLITT across five procedures, treating metastatic foci from primary sacral, clival, and cervical chordomas, as well as one primary thoracic lesion. sLITT was used as salvage treatment in four procedures and as primary treatment in one patient to avoid the morbidity of open surgery. Median time from diagnosis to LITT was 19.1 months (range 2.5-168.3), and pre-operative KPS was 90-100 in all patients. A median of four laser fibers and 16 ablations were used per procedure (12-15 W). Median case duration was 352.5 min and length of stay was two days. Postoperative SRS was administered in all but one procedure. All patients experienced volumetric tumor reduction on the earliest post-operative MRI (median 4.2 months, range 2.8-8.8), with a mean reduction of 25.7% ± 12.7%. Median radiographic follow-up was 16.8 months (range 3.5-48.1). No procedure required additional intervention at the LITT-treated site, and no progression at the treated site was identified on available follow-up imaging. Median overall survival from LITT was 23.0 months. One procedure was complicated by transient radiculopathy that resolved with steroids. Literature review identified four previously published case reports of LITT for chordoma, three of which described complete thermal ablation with radiographic response; our series represents the largest reported clinical experience to date.

conclusionThis series represents the largest reported clinical experience with LITT for chordoma and provides proof-of-concept supporting prospective evaluation of this technique. sLITT was technically feasible and well tolerated in this small chordoma cohort, applied both as salvage therapy and, in one patient, as primary local treatment. Because SRS followed all but one procedure, the independent contribution of sLITT to the radiographic responses observed cannot be determined from these data.