Outcomes and Patterns of Care in Adult Skull Base Chondrosarcoma Patients in the United States

Patel, Saavan; Nunna, Ravi S; Ryoo, James S; Ansari, Darius; Chaudhry, Nauman S.; Mehta, Ankit I.

doi:10.1016/j.wneu.2021.03.097

Cited by 8 publications

(16 citation statements)

References 32 publications

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“…With regards to the extent-of-surgery, different authors argued for aggressive gross total resection or safe cytoreduction with adjuvant radiotherapy, weighting surgical risks against benefits in terms of local tumor control and survival [ 15 , 25 , 27 ]. More recently, Patel et al [ 11 ] analyzed the United States national cancer database and found no significant differences between partial and radical SBCs resection, but advocated functional-sparing subtotal resection followed by adjuvant radiotherapy, achieving satisfactory outcomes without sacrificing patients’ functional status. When subtotal resection is planned however, it must be done with the optimal parameters for radiotherapy in mind, to ensure the minimal number of surgeries possible without compromising optimal radiation dosing or increasing radiation complications.…”

Section: Discussionmentioning

confidence: 99%

“…The main goals of surgery are tissue diagnosis and maximal safe resection, in order to prevent neurological deterioration, optimize conditions for dose-escalated adjuvant radiotherapy, and improve survival. Gross total resection is safely feasible in some cases, but has higher risks of postoperative neuropathies and vascular injuries [ 11 , 12 ]. Thus, adjuvant radiotherapy is often administered to treat any residual disease following safe maximal cytoreduction, further enhancing local tumor control and survival [ 11 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Gross total resection is safely feasible in some cases, but has higher risks of postoperative neuropathies and vascular injuries [ 11 , 12 ]. Thus, adjuvant radiotherapy is often administered to treat any residual disease following safe maximal cytoreduction, further enhancing local tumor control and survival [ 11 , 13 ]. Novel proton-based and carbon ion-based radiotherapy modalities have also been studied to focus high dose radiation beams to selected tumor targets, reducing radiation-induced toxicities to the normal brain tissue [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Primary Skull Base Chondrosarcomas: A Systematic Review

Palmisciano

Haider

Sabahi

et al. 2021

Cancers

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Background: Primary skull base chondrosarcomas (SBCs) can severely affect patients’ quality of life. Surgical-resection and radiotherapy are feasible but may cause debilitating complications. We systematically reviewed the literature on primary SBCs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients with primary SBCs. Clinical characteristics, management strategies, and treatment outcomes were analyzed. Results: We included 33 studies comprising 1307 patients. Primary SBCs mostly involved the middle-fossa (72.7%), infiltrating the cavernous-sinus in 42.4% of patients. Cranial-neuropathies were reported in 810 patients (62%). Surgical-resection (93.3%) was preferred over biopsy (6.6%). The most frequent open surgical approaches were frontotemporal-orbitozygomatic (17.6%) and pterional (11.9%), and 111 patients (21.3%) underwent endoscopic-endonasal resection. Post-surgical cerebrospinal-fluid leaks occurred in 36 patients (6.5%). Radiotherapy was delivered in 1018 patients (77.9%): photon-based (41.4%), proton-based (64.2%), and carbon-based (13.1%). Severe post-radiotherapy complications, mostly hypopituitarism (15.4%) and hearing loss (7.1%) were experienced by 251 patients (30.7%). Post-treatment symptom-improvement (46.7%) and reduced/stable tumor volumes (85.4%) showed no differences based on radiotherapy-protocols (p = 0.165; p = 0.062). Median follow-up was 67-months (range, 0.1–376). SBCs recurrences were reported in 211 cases (16.1%). The 5-year and 10-year progression-free survival rates were 84.3% and 67.4%, and overall survival rates were 94% and 84%. Conclusion: Surgical-resection and radiotherapy are effective treatments in primary SBCs, with acceptable complication rates and favorable local tumor control.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Primary Skull Base Chondrosarcomas: A Systematic Review

Palmisciano

Haider

Sabahi

et al. 2021

Cancers

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“…It is considered to be cartilage residue caused by the incomplete ossification of the cartilaginous skull [ 3 ]. Because of the special anatomical location, chondrosarcoma of the skull base often invades the petroclival area, parasellar area, and jugular foramen area; causing the erosion of important arteries and cranial nerves [ 4 , 5 , 6 , 7 , 8 ]; and penetrating the dura mater to compress the brain stem [ 8 ]. Therefore, achieving complete removal by surgery is very challenging [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The invasiveness of skull base chondrosarcoma greatly increases the difficulty of surgical resection. Based on maximum tumor resection, adjuvant radiotherapy is often used to control residual tumors [ 7 ]. Although proton therapy protects key parts at a higher therapeutic dose [ 7 ], patients with parasellar chondrosarcoma are at a higher risk of vision loss after treatment [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Prognostic Risk Factors of Parasellar Chondrosarcoma

Zhang

Wang

et al. 2022

Brain Sciences

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Background: Parasellar chondrosarcomas are extremely rare. This study describes the characteristics of parasellar chondrosarcoma and analyzes the risk factors and prognosis based on the resection degree. Methods: Fifteen patients with pathologically diagnosed parasellar chondrosarcoma were retrospectively analyzed for the clinical data, surgical methods, and prognosis to identify relationships between the surgical resection degree, tumor recurrence, and imaging characteristics. Results: Twelve patients had eye dysfunction and ptosis. Differentiation from other parasellar tumors by imaging is difficult. The preoperative Karnofsky Performance Scale (KPS) score positively correlated with the tumor resection degree (p = 0.026) and negatively correlated with the maximum tumor diameter (p = 0.001). Tumor recurrence negatively correlated with the resection degree (p = 0.009). The postoperative KPS score positively correlated with the preoperative KPS score (p < 0.001) and tumor resection degree (p = 0.026), and negatively correlated with the maximum tumor diameter (p = 0.016) and age (p = 0.047). An improved KPS score positively correlated with the tumor resection degree (p = 0.039). Patients who underwent total resection of the chondrosarcoma had longer progression-free survival than those who underwent partial resection (p = 0.0322). Conclusion: Parasellar chondrosarcomas are difficult to resect completely. Preoperative KPS score is an important factor for the degree of resection. KPS score, age, maximum tumor diameter, and resection degree may be important prognostic factors.

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