Tumour seeding in the surgical pathway after resection of skull base chordoma

Krengli, Marco; Poletti, Alessandro; Ferrara, Eleonora; Fossati, Piero

doi:10.1016/j.rpor.2016.02.005

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…There have been several reports with recurrence in which authors believe seeding along the surgical pathway may have played a role, particularly in open cases . It can be difficult to attribute a recurrence to “seeding” and no definitive consensus has emerged regarding this; however, it has been suggested that minimally invasive techniques such as the EEA may limit seeding .…”

Section: Clival Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Clival Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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“…Of the patients treated with proton therapy after surgery, 26% still develop recurrence [9], and local recurrence is the predominant form of treatment failure [10]. Recurrences are also described in the vicinity, but outside of the primary tumor bed, as well as at a distance [11,12]. Ectopic recurrences are defined as recurrences outside of the primary tumor bed.…”

Section: Introductionmentioning

confidence: 99%

Ectopic Recurrence of Skull Base Chordoma after Proton Therapy

et al. 2022

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Background: Chordoma are rare tumors of the axial skeleton. The treatment gold standard is surgery, followed by particle radiotherapy. Total resection is usually not achievable in skull base chordoma (SBC) and high recurrence rates are reported. Ectopic recurrence as a first sign of treatment failure is considered rare. Favorable sites of these ectopic recurrences remain unknown. Methods: Five out of 16 SBC patients treated with proton therapy and surgical resection developed ectopic recurrence as a first sign of treatment failure were critically analyzed regarding prior surgery, radiotherapy, and recurrences at follow-up imaging. Results: Eighteen recurrences were defined in five patients. A total of 31 surgeries were performed for primary tumors and recurrences. Seventeen out of eighteen (94%) ectopic recurrences could be related to prior surgical tracts, outside the therapeutic radiation dose. Follow-up imaging showed that tumor recurrence was difficult to distinguish from radiation necrosis and anatomical changes due to surgery. Conclusions: In our cohort, we found uncommon ectopic recurrences in the surgical tract. Our theory is that these recurrences are due to microscopic tumor spill during surgery. These cells did not receive a therapeutic radiation dose. Advances in surgical possibilities and adjusted radiotherapy target volumes might improve local control and survival.

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“…However, seeding from PLC on the thoracoabdominal wall is the most unfavorable complication, which occasionally emerges after the percutaneous procedures or surgery. [10][11][12] Recently, risk of seeding after percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation varied from 0.3% to 1.9%, from 0.005% to 12.5%, from 0.44% to 0.75% and 0.76% in previous reports respectively, has received increased attention from clinicians. [13][14][15][16][17][18] Based on appropriate choice by the patient and careful attention to the ablation procedure, several studies showed low seeding rate after ablation.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a clinicopathological‐based nomogram to predict seeding risk after percutaneous thermal ablation of primary liver carcinoma

Huang

et al. 2020

Cancer Medicine

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Objectives To develop a clinicopathological‐based nomogram to improve the prediction of the seeding risk of after percutaneous thermal ablation (PTA) in primary liver carcinoma (PLC). Methods A total of 2030 patients with PLC who underwent PTA were included between April 2009 and December 2018. The patients were grouped into a training dataset (n = 1024) and an external validation dataset (n = 1006). Baseline characteristics were collected to identify the risk factors of seeding after PTA. The multivariate Cox proportional hazards model based on the risk factors was used to develop the nomogram, which was used for assessment for its predictive accuracy using mainly the Harrell's C‐index and receiver operating characteristic curve (AUC). Results The median follow‐up time was 30.3 months (range, 3.2‐115.7 months). The seeding risk was 0.89% per tumor and 1.5% per patient in the training set. The nomogram was developed based on tumor size, subcapsular, α‐fetoprotein (AFP), and international normalized ratio (INR). The 1‐, 2‐, and 3‐year cumulative seeding rates were 0.1%, 0.7% and 1.2% in the low‐risk group, and 1.7%, 6.3% and 6.3% in the high‐risk group, respectively, showing significant statistical difference (P < .001). The nomogram had good calibration and discriminatory abilities in the training set, with C‐indexes of 0.722 (95% confidence interval [CI]: 0.661, 0.883) and AUC of 0.850 (95% CI: 0.767, 0.934). External validation with 1000 bootstrapped sample sets showed a good C‐index of 0.706 (95% CI: 0.546, 0.866) and AUC of 0.736 (95% CI: 0. 646, 0.827). Conclusions The clinicopathological‐based nomogram could be used to quantify the probability of seeding risk after PTA in PLC.

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Tumour seeding in the surgical pathway after resection of skull base chordoma

Cited by 12 publications

References 28 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Ectopic Recurrence of Skull Base Chordoma after Proton Therapy

Development and validation of a clinicopathological‐based nomogram to predict seeding risk after percutaneous thermal ablation of primary liver carcinoma

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