Disease outcomes for skull base and spinal chordomas: A single center experience

Ahmed, Raheel; Sheybani, Arshin; Menezes, Arnold H.; Buatti, John M.; Hitchon, Patrick W.

doi:10.1016/j.clineuro.2014.12.015

Cited by 34 publications

(25 citation statements)

References 27 publications

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“…The results of survival rates in this series showed a slight improvement compared with our prior series, in which the 5-year OS rate was 67.6%, 33 and were similar to the results presented by the 10-year meta-analysis, in which the weighted average 5-year OS and PFS rates were 78.4% and 50.8%, respectively. 13 This can partly be attributed to improvement in physicians' understanding of this tumor, as well as our consistent surgical philosophy, which is similar to the philosophy of other authors, 1,5,9,21,23 that radical resection should be performed when feasible.…”

Section: Role Of Tumor Resection On Survivalsupporting

confidence: 62%

Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Wang

Tian

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Skull base chordoma is relatively rare, and a limited number of reports have been published regarding its clinical features. Moreover, the factors associated with extent of resection, as well as the value of marginal resection for long-term survival, are still in question for this disease. The objective of this study was to investigate these factors by evaluating their clinical features and surgical outcomes. METHODS A retrospective analysis of 238 patients with skull base chordomas, who met the inclusion criteria, was performed. This study summarized the clinical features, selection of approaches, degree of resection, and postoperative complications by statistical description analyses; proposed modified classifications of tumor location and bone invasion; studied the contributions of the clinical and radiological factors to the extent of resection by Pearson χ, ANOVA, rank test, and binary logistic regression analysis; and estimated the differences in overall survival and progression-free survival rates with respect to therapeutic history, classification of tumor location, extent of bone invasion, and extent of tumor resection by the Kaplan-Meier method. A p value < 0.05 was considered statistically significant. RESULTS The study included 140 male and 98 female patients with a mean age of 38.1 years. Headache and neck pain (33.2%) and diplopia (29%) were the most common initial symptoms. Sphenoclival type accounted for the largest proportion of tumor location (59.2%); endophytic chordoma was the more common type of bone invasion (81.5%). Lateral open approaches were performed in two-thirds of the study population (78.6%). The rate of marginal resection was 66%, composed of gross-total resection (11.8%) and near-total resection (54.2%). Meningitis (8%) and CSF leakage (3.8%) were the most frequent complications. The mean follow-up period was 43.7 months. The overall survival and progression-free survival rates at 5 years were 76% and 45%, respectively. Recurrent tumor and larger tumor volume (≥ 40 cm) were identified as risk factors of marginal resection. Patients who presented with recurrent tumor and underwent intralesional resection had a worse long-term outcome. CONCLUSIONS The classifications of both tumor location and bone invasion demonstrated clinical value. Marginal resection was more likely to be achieved for primary lesions with smaller volumes (< 40 cm). The rate of CSF leakage declined due to improved dura mater repair with free fat grafts. Marginal resection, or gross-total resection when possible, should be performed in patients with primary chordomas to achieve better long-term survival.

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Section: Role Of Tumor Resection On Survivalsupporting

confidence: 62%

Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Wang

Tian

et al. 2017

Journal of Neurosurgery

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“…Pain is the most common presenting symptom of chordomas (7,17,18). Patients may also present with neurologic symptoms if the mass compresses the spinal cord or nerve roots.…”

Section: Presentationmentioning

confidence: 99%

“…En bloc surgical resection with a circumferential margin of uninvolved tissue has been considered standard initial management of chordomas if they are surgically resectable (4,19). Ahmed et al found 10-year survival rates of 88% and 31% in patients who had undergone total resection compared to subtotal resection (17). Additionally, Shah et al recently round that TES for spinal tumors, including chordomas, resulted in only a 6.3% tumor recurrence rate (20).…”

Section: Managementmentioning

confidence: 99%

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Chordoma of the mobile spine and sacrum: clinical management and prognosis

D’Amore

Mesfin

2018

J Spine Surg

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Background: Chordomas are rare malignant tumors of the spinal column often afflicting the upper cervical spine and sacrum. There are few large single center series on chordomas due to its rarity. The purpose of this study is to report a single center's experience with the operative and non-operative management of chordomas. Methods: We evaluated our institution's pathology database from 1994 to 2016 to identify patients diagnosed with chordomas. Inclusion criteria were chordomas of the mobile spine and sacrum. Exclusion criteria were chordomas of the clivus and resection performed at another institution. We collected patient demographics as well as the type of resection performed, intra-operative complications, wound complications and recurrence/prognosis. Results: We identified 18 patients diagnosed with chordomas at our institution, and 12 met our inclusion criteria. There were four females and eight males with an average age of 64 [32-87] years. All patients were Caucasian and 10 of the 12 had surgery. Of the two patients with sacral chordomas that did not have surgery, one received chemotherapy and the other did not elect for any treatment. One is alive 161 months following diagnosis and the second died 96 months following diagnosis. Five of the lesions were in the mobile spine (one cervical, two thoracic, two lumbar) and seven were in the sacrum. Six patients underwent an en bloc resection [two via total en bloc spondylectomy (TES)]. Average length of follow up is 60 [3-161] months and eight of 12 patients are alive at latest follow up. Intraoperative complications included cardiac arrest, pleural tear, and excessive blood loss (8 L). Two patients, with sacral chordomas, had wound complications. Recurrence occurred in one patient with piecemeal resection and one patient with incomplete resection had postoperative metastatic lesions to the liver and lung. Conclusions: We found less recurrence in patients managed with an en bloc resection as opposed to piece meal or intralesional resections. Sacral chordoma patients had higher wound complication rates as compared to chordomas of the mobile spine. The long life expectancy of non-surgically managed patients underscores the indolent nature of chordomas.

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“…The treatment of chordomas is challenging because they lie close to critical structures such as cranial nerves, the brain stem, and spinal cord and nerves. These anatomical locations make curative resection difficult, and the tumors often recur after surgery [ 2 ]. Therefore, post-operative radiotherapy is indicated in most cases [ 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome of proton therapy for patients with chordomas

et al. 2018

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PurposeTo investigate the clinical outcome of proton therapy (PT) in patients with chordoma.Materials and MethodsFifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and diseasespecific survival (DSS) rates were calculated by the Kaplan–Meier method.ResultsWith the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4.ConclusionPT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.

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Disease outcomes for skull base and spinal chordomas: A single center experience

Cited by 34 publications

References 27 publications

Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Chordoma of the mobile spine and sacrum: clinical management and prognosis

Clinical outcome of proton therapy for patients with chordomas

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