Endoscopic endonasal resection and radiotherapy as treatment for skull base chordomas

Li, Hongbing; Zhang, Huankang; Hu, Li; Wang, Huan; Wang, Dehui

doi:10.1080/00016489.2020.1748225

Cited by 8 publications

(9 citation statements)

References 19 publications

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“…Adjuvant RT is a widely accepted treatment for residual chordomas [40,19], although no strong evidence supports it [31]. We found that PFS and CSS were signi cantly longer in patients with pre-recurrence RT than in other patients, which is similar to prior studies [14,34].…”

Section: Timing Of Rt and Outcomesupporting

confidence: 81%

“…It remains debatable whether to undertake pre-recurrence RT after GTR [9,23,19]. Lately, Yagiz Yolcu et al's found that compared with GTR alone, GTR plus RT did not offer any signi cant survival bene t for patients with sacral or spinal chordomas, at the price of higher complications rate [33].…”

Section: Rt After Gtrmentioning

confidence: 99%

“…Therefore, pre-recurrence RT is recommended to prevent recurrence even after GTR for patients with SBCs [19].…”

Section: Rt After Gtrmentioning

confidence: 99%

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Long Follow-up Surgical Results in 284 Cases of Clival Chordomas: The Risk Factors for Outcome and Tumor Recurrence

bai

Shi

et al. 2021

Preprint

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OBJECTIVE: Skull-base chordoma (SBC) is rare and one of the most challenging diseases to treat. We aimed to assess the optimal timing of adjuvant radiation therapy (RT) and evaluate the factors that influence resection and long-term outcomes.METHODS: In total, 284 patients with 382 surgeries were enrolled in this retrospective study. Postsurgically, 64 patients underwent RT before recurrence (pre-recurrence RT), and 47 patients underwent RT after recurrence. During the first attempt to achieve gross-total resection (GTR), when the entire tumor was resected, 268 patients were treated with an endoscopic midline approach, and 16 patients were treated with microscopic lateral approaches. Factors associated with the success of GTR were identified using c2 and logistic regression analyses. Risk factors associated with chordoma-specific survival (CSS) and progression-free survival (PFS) were evaluated with the Cox proportional hazards model.RESULTS: In total, 74.6% of tumors were marginally resected [GTR (40.1%); near-total resection (34.5%)]. History of surgery, large tumor volumes and tumor locations in the lower clivus were associated with a lower GTR rate. The mean follow-up period was 43.9 months. At last follow-up, 181 (63.7%) patients were alive. RT history, histologic subtype (dedifferentiated and sarcomatoid), non-GTR, no postsurgical RT, and the presence of metastasis were associated with poorer CSS. Patients with pre-recurrence RT had the longest PFS and CSS, while patients without postsurgical RT had the worst outcome.CONCLUSION: GTR is the goal of initial surgical treatment. Pre-recurrence RT would improve outcome regardless of GTR.

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Section: Timing Of Rt and Outcomesupporting

confidence: 81%

Section: Rt After Gtrmentioning

confidence: 99%

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Long Follow-up Surgical Results in 284 Cases of Clival Chordomas: The Risk Factors for Outcome and Tumor Recurrence

bai

Shi

et al. 2021

Preprint

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“…This equivalence was recently confirmed in several retrospective comparisons [ 14 , 17 , 33 ]. After surgical resection, high-dose radiation therapy is therefore indicated and can improve overall survival and local control, and particle therapy is considered the radiation modality of choice [ 15 , 17 , 31 , 34 ].…”

Section: Established Treatment Strategymentioning

confidence: 99%

“…In the large majority of particle therapy series, gross tumor volume correlated with local control, and patients with small residual disease had a better outcome [ 22 , 24 , 26 – 29 , 36 , 37 ]. Moreover, several series demonstrated a correlation between compression of brainstem and/or optic pathways and outcome [ 26 , 29 , 34 ]. Finally, target coverage emerged as another factor strongly predictive of outcome [ 23 , 27 , 29 , 37 ].…”

Section: Future Developmentsmentioning

confidence: 99%

A Review of Particle Therapy for Skull Base Tumors: Modern Considerations and Future Directions

Hug

Pelak

Frank

et al. 2021

International Journal of Particle Therapy

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Skull base tumors constitute one of the established indications for particle therapy, specifically proton therapy. However, a number of prognostic factors, practical clinical management issues, and the emerging role of carbon ion therapy remain subjects of active clinical investigation. This review summarizes these topics, assesses the present status, and reflects on future research directions focusing on the management of chordomas, one of the most aggressive skull base tumors. In addition, the role of particle therapy for benign tumors of the skull base, including pituitary adenoma and acoustic neuroma, is reviewed.

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Mid-term follow-up surgical results in 284 cases of clival chordomas: the risk factors for outcome and tumor recurrence

Bai

Shi

et al. 2021

Neurosurg Rev

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Objective Skull base chordoma (SBC) is rare and one of the most challenging diseases to treat. We aimed to assess the optimal timing of adjuvant radiation therapy (RT) and to evaluate the factors that influence resection and long-term outcomes. Methods In total, 284 patients with 382 surgeries were enrolled in this retrospective study. Postsurgically, 64 patients underwent RT before recurrence (pre-recurrence RT), and 47 patients underwent RT after recurrence. During the first attempt to achieve gross-total resection (GTR), when the entire tumor was resected, 268 patients were treated with an endoscopic midline approach, and 16 patients were treated with microscopic lateral approaches. Factors associated with the success of GTR were identified using χ2 and logistic regression analyses. Risk factors associated with chordoma-specific survival (CSS) and progression-free survival (PFS) were evaluated with the Cox proportional hazards model. Results In total, 74.6% of tumors were marginally resected [GTR (40.1%), near-total resection (34.5%)]. History of surgery, large tumor volumes, and tumor locations in the lower clivus were associated with a lower GTR rate. The mean follow-up period was 43.9 months. At the last follow-up, 181 (63.7%) patients were alive. RT history, histologic subtype (dedifferentiated and sarcomatoid), non-GTR, no postsurgical RT, and the presence of metastasis were associated with poorer CSS. Patients with pre-recurrence RT had the longest PFS and CSS, while patients without postsurgical RT had the worst outcome. Conclusion GTR is the goal of initial surgical treatment. Pre-recurrence RT would improve outcome regardless of GTR.

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Endoscopic endonasal resection and radiotherapy as treatment for skull base chordomas

Cited by 8 publications

References 19 publications

Long Follow-up Surgical Results in 284 Cases of Clival Chordomas: The Risk Factors for Outcome and Tumor Recurrence

Long Follow-up Surgical Results in 284 Cases of Clival Chordomas: The Risk Factors for Outcome and Tumor Recurrence

A Review of Particle Therapy for Skull Base Tumors: Modern Considerations and Future Directions

Mid-term follow-up surgical results in 284 cases of clival chordomas: the risk factors for outcome and tumor recurrence

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