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Agner KE, Larkins MC. Comparative overall survival analysis of chordomas of the base of the skull from the Surveillance, Epidemiology, and End Results (SEER) program between 2000 and 2020. Neurosurg Rev 2024; 47:683. [PMID: 39320522 PMCID: PMC11424729 DOI: 10.1007/s10143-024-02815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/26/2024]
Abstract
Chordomas of the skull base are rare, slow growing, locally invasive cancers with limited long-term survival analysis reported in the literature. We seek to provide comparative survival analysis of patients on a long-term (20-year) basis using population-level data. The Surveillance, Epidemiology, and End Results (SEER) program was queried for cases of chordoma relegated to the base of the skull, diagnosed between 2000 and 2020. Demographic, disease, and treatment information were analyzed using Cox proportional hazards and log-rank comparisons. 630 patients with chordoma of the skull base were identified. Age ≤ 49 years at diagnosis was associated with increased five-, 10-, and 20-year overall survival (hazard ratio (HR) = 0.39, 0.33, and 0.30, respectively; p < 0.001 for all). Treatment with surgery and adjuvant radiotherapy was associated with increased five-, 10-, and 20-year survival (HR = 0.71, 0.79, and 0.79, respectively; p < 0.001 for all). On univariate analysis, widowed patients had decreased survival (20-year overall survival = 34.8% [15.3%-34.8%] compared to married patients (74.4% [68.1%-80.8%]. Surgery remains the primary treatment associated with increased survival among patients with chordoma of the skull base, with adjuvant radiotherapy serving a complimentary role. Demographic factors such as marital status are also associated with changes in survival.
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Affiliation(s)
- Kevin E Agner
- The Ohio State University College of Medicine, 370 W. 9Th Avenue, Columbus, OH, 43210, USA
| | - Michael C Larkins
- East Carolina University Brody School of Medicine, 600 Moye Blvd, Greenville, NC, 27834, USA.
- Department of Emergency Medicine, Boonshoft School of Medicine at Wright State University, 2555 University Blvd, Fairborn, OH, USA.
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Skotting MB, Poulsgaard L, Springborg JB, Sundbye F, Engelmann BE, Scheie D, Ciochon UM, Guldberg F, Fugleholm K. Clival chordomas and chondrosarcomas in Denmark-Outcomes in 33 patients following the national centralization of treatment in 2010. Acta Neurochir (Wien) 2024; 166:354. [PMID: 39207554 PMCID: PMC11362515 DOI: 10.1007/s00701-024-06241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This 13-year consecutive case series aims to provide a comprehensive overview of all patients operated for clival chordomas and clival chondrosarcomas in Denmark since the centralization of treatment in 2010, comparing outcomes to international series. METHODS This was a retrospective review of 33 patients with clival tumors, comprising 22 chordomas and 11 chondrosarcomas, who were treated at Copenhagen University Hospital between years 2010 and 2023. Data were collected from digital patient records and pathology reports. RESULTS The symptoms leading to diagnosis primarily included double vision, headaches, and dizziness. In general, patients were in good health, with a mean Charlson Comorbidity Index score of 1.6. The complication rate of the index surgery was 51.5%. Adjuvant radiotherapy was applied in 51.5% of the cases. In patients with clival chordomas, the mean age was 51.1 years, ranging from 16 to 83 years. At the time of diagnosis, the mean tumor volume was 20.9 cm3 and the five-year overall survival rates were 79.1% (95% confidence interval (CI): 62.4-100). In patients with chondrosarcomas, the mean age was 48.2 years, ranging from 15 to 76 years. At the time of diagnosis, the mean tumor volume was 22.3 cm3 and the five-year overall survival 90% (95% CI: 73.2-100). CONCLUSION The centralized treatment of clival tumors in Denmark demonstrates incidence, survival, and complication rates comparable to those found in other international series. Given the variations in treatment strategies, tumor localizations across series, and small sample sizes, the further analysis of larger compiled multicenter datasets for clival tumors could provide more solid evidence regarding the management of these rare tumors.
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Affiliation(s)
| | - Lars Poulsgaard
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Filippa Sundbye
- Department of Oncology, Hospital of Herlev and Gentofte, Herlev, Denmark
| | - Bodil Elisabeth Engelmann
- Department of Oncology, Hospital of Herlev and Gentofte, Herlev, Denmark
- Danish Particle Center, Aarhus University Hospital, Aarhus, Denmark
| | - David Scheie
- Department of Diagnostic Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Urszula Maria Ciochon
- Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederikke Guldberg
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
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3
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Maugeri R, Bonosi L, Brunasso L, Costanzo R, Santi S, Signorelli F, Iacopino DG, Visocchi M. Not Every Size Fits All: Surgical Corridors for Clival and Cervical Chordomas-A Systematic Review of the Literature and Illustrative Cases. J Clin Med 2024; 13:5052. [PMID: 39274265 PMCID: PMC11396282 DOI: 10.3390/jcm13175052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
Introduction. Clival chordomas represent a rare but clinically significant subset of skull base tumors, characterized by a locally aggressive nature and a location in proximity to vital neurovascular structures. Surgical resection, often combined with adjuvant therapies, remains the cornerstone of clival chordoma treatment, and various approaches and techniques have evolved to maximize tumor removal while preserving neurological function. Recent advancements in skull base surgery, imaging, and adjuvant therapies have improved outcomes by reducing morbidity and thus enhancing long-term survival. Methods and Results. We have conducted a systematic review on PubMed/Medline following PRISMA guidelines regarding indications, the extent of resection (EOR), and complication rates. Then, we present three illustrative cases from our personal experience, which started 25 years ago with CVJ instrumentation procedures and 15 years ago with anterior decompressive transmucosal procedures performed with the aid of an operative microscope, an endoscope, and neuroradiological monitoring. Conclusions. Traditionally, the transoral approach (TOA) is the most frequently used corridor for accessing the lower clivus and the anterior craniovertebral junction (CVJ), without the need to mobilize or retract neural structures; however, it is associated with a high rate of complications. The endonasal approach (EEA) provides access to the anterior CVJ as well as to the lower, middle, and superior clivus, decreasing airway and swallowing morbidity, preserving palatal function, decreasing postoperative pain, and reducing the incidence of tracheostomy. The submandibular retropharyngeal approach (SRA) allows unique access to certain cervical chordomas, which is better suited when the lesion is located below the clivus and in the midline.
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Affiliation(s)
- Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Lapo Bonosi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Samuele Santi
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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Saito T, Mizumoto M, Oshiro Y, Shimizu S, Li Y, Nakamura M, Hosaka S, Nakai K, Iizumi T, Inaba M, Fukushima H, Suzuki R, Maruo K, Sakurai H. Systematic Review and Meta-Analysis of Particle Beam Therapy versus Photon Radiotherapy for Skull Base Chordoma: TRP-Chordoma 2024. Cancers (Basel) 2024; 16:2569. [PMID: 39061207 PMCID: PMC11274426 DOI: 10.3390/cancers16142569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
[Objective] The aim of this study was to compare the efficacy of particle beam therapy (PT) with photon radiotherapy (RT) for treatment of skull base chordoma. [Methods] A systematic review was conducted for skull base chordoma treated with PT or photon RT reported from 1990 to 2022. Data were extracted for overall survival (OS) and progression-free survival (PFS), late adverse events, age, gender, gross total resection (GTR) rates, tumor volume, total irradiation dose, and treatment modality. Random-effects meta-regression analysis with the treatment modality as an explanatory variable was performed for each outcome to compare the modalities. [Results] A meta-analysis of 30 selected articles found 3- and 5-year OS rates for PT vs. photon RT or combined photon RT/proton beam therapy (PBT) of 90.8% (95% CI: 87.4-93.3%) vs. 89.5% (95% CI: 83.0-93.6%), p = 0.6543; 80.0% (95% CI: 75.7-83.6%) vs. 89.5% (95% CI: 83.0-93.6%), p = 0.6787. The 5-year PFS rates for PT vs. photon RT or photon RT/PBT were 67.8% (95% CI: 56.5-76.7%) vs. 40.2% (95% CI: 31.6-48.7%), p = 0.0004. A random-effects model revealed that the treatment modality (PT vs. photon RT or photon RT/PBT) was not a significant factor for 3-year OS (p = 0.42) and 5-year OS (p = 0.11), but was a significant factor for 5-year PFS (p < 0.0001). The rates of brain necrosis were 8-50% after PT and 0-4% after photon RT or photon RT/PBT. [Conclusion] This study shows that PT results in higher PFS compared to photon RT for skull base chordoma, but that there is a tendency for a higher incidence of brain necrosis with PT. Publication and analysis of further studies is needed to validate these findings.
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Affiliation(s)
- Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan; (T.S.); (Y.L.); (M.N.); (K.N.); (T.I.); (H.S.)
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan; (T.S.); (Y.L.); (M.N.); (K.N.); (T.I.); (H.S.)
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba 305-8558, Ibaraki, Japan;
| | - Shosei Shimizu
- Department of Pediatric Radiation Therapy Center/Pediatric Proton Beam Therapy Center, Hebei Yizhou Cancer Hospital, Zhuozhou 072750, China;
| | - Yinuo Li
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan; (T.S.); (Y.L.); (M.N.); (K.N.); (T.I.); (H.S.)
| | - Masatoshi Nakamura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan; (T.S.); (Y.L.); (M.N.); (K.N.); (T.I.); (H.S.)
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8575, Ibaraki, Japan; (S.H.); (M.I.); (H.F.); (R.S.)
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan; (T.S.); (Y.L.); (M.N.); (K.N.); (T.I.); (H.S.)
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan; (T.S.); (Y.L.); (M.N.); (K.N.); (T.I.); (H.S.)
| | - Masako Inaba
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8575, Ibaraki, Japan; (S.H.); (M.I.); (H.F.); (R.S.)
| | - Hiroko Fukushima
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8575, Ibaraki, Japan; (S.H.); (M.I.); (H.F.); (R.S.)
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
| | - Ryoko Suzuki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8575, Ibaraki, Japan; (S.H.); (M.I.); (H.F.); (R.S.)
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan;
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan; (T.S.); (Y.L.); (M.N.); (K.N.); (T.I.); (H.S.)
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Oura T, Shimono T, Horiuchi D, Goto T, Takita H, Tsukamoto T, Tatekawa H, Ueda D, Matsushita S, Mitsuyama Y, Atsukawa N, Miki Y. Evaluation of cranial nerve involvement in chordomas and chondrosarcomas: a retrospective imaging study. Neuroradiology 2024; 66:955-961. [PMID: 38407581 DOI: 10.1007/s00234-024-03322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Cranial nerve involvement (CNI) influences the treatment strategies and prognosis of head and neck tumors. However, its incidence in skull base chordomas and chondrosarcomas remains to be investigated. This study evaluated the imaging features of chordoma and chondrosarcoma, with a focus on the differences in CNI. METHODS Forty-two patients (26 and 16 patients with chordomas and chondrosarcomas, respectively) treated at our institution between January 2007 and January 2023 were included in this retrospective study. Imaging features, such as the maximum diameter, tumor location (midline or off-midline), calcification, signal intensity on T2-weighted image, mean apparent diffusion coefficient (ADC) values, contrast enhancement, and CNI, were evaluated and compared using Fisher's exact test or the Mann-Whitney U-test. The odds ratio (OR) was calculated to evaluate the association between the histological type and imaging features. RESULTS The incidence of CNI in chondrosarcomas was significantly higher than that in chordomas (63% vs. 8%, P < 0.001). An off-midline location was more common in chondrosarcomas than in chordomas (86% vs. 13%; P < 0.001). The mean ADC values of chondrosarcomas were significantly higher than those of chordomas (P < 0.001). Significant associations were identified between chondrosarcomas and CNI (OR = 20.00; P < 0.001), location (OR = 53.70; P < 0.001), and mean ADC values (OR = 1.01; P = 0.002). CONCLUSION The incidence of CNI and off-midline location in chondrosarcomas was significantly higher than that in chordomas. CNI, tumor location, and the mean ADC can help distinguish between these entities.
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Affiliation(s)
- Tatsushi Oura
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daisuke Horiuchi
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takeo Goto
- Department of Neurosurgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hirotaka Takita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Taro Tsukamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyuki Tatekawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shu Matsushita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yasuhito Mitsuyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Natsuko Atsukawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Nakamura M, Mizumoto M, Saito T, Shimizu S, Li Y, Oshiro Y, Inaba M, Hosaka S, Fukushima H, Suzuki R, Iizumi T, Nakai K, Maruo K, Sakurai H. A systematic review and meta-analysis of radiotherapy and particle beam therapy for skull base chondrosarcoma: TRP-chondrosarcoma 2024. Front Oncol 2024; 14:1380716. [PMID: 38567162 PMCID: PMC10985235 DOI: 10.3389/fonc.2024.1380716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Chondrosarcoma is a rare malignant bone tumor. Particle beam therapy (PT) can concentrate doses to targets while reducing adverse events. A meta-analysis based on a literature review was performed to examine the efficacy of PT and photon radiotherapy for skull base chondrosarcoma. Methods The meta-analysis was conducted using 21 articles published from 1990 to 2022. Results After PT, the 3- and 5-year overall survival (OS) rates were 94.1% (95% confidence interval [CI]: 91.0-96.2%) and 93.9% (95% CI: 90.6-96.1%), respectively, and the 3- and 5-year local control rates were 95.4% (95% CI: 92.0-97.4%) and 90.1% (95% CI: 76.8-96.0%), respectively. Meta-regression analysis revealed a significant association of PT with a superior 5-year OS rate compared to three-dimensional conformal radiotherapy (p < 0.001). In the studies used in the meta-analysis, the major adverse event of grade 2 or higher was temporal lobe necrosis (incidence 1-18%, median 7%). Conclusion PT for skull base chondrosarcoma had a good outcome and may be a valuable option among radiotherapy modalities. However, high-dose postoperative irradiation of skull base chondrosarcoma can cause adverse events such as temporal lobe necrosis.
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Affiliation(s)
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Shosei Shimizu
- Department of Pediatric Radiation Therapy Center/Pediatric Proton Beam Therapy Center, Hebei Yizhou Cancer Hospital, Zhuozhou, China
| | - Yinuo Li
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masako Inaba
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hiroko Fukushima
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryoko Suzuki
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
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Varachev V, Shekhtman A, Guskov D, Rogozhin D, Zasedatelev A, Nasedkina T. Diagnostics of IDH1/2 Mutations in Intracranial Chondroid Tumors: Comparison of Molecular Genetic Methods and Immunohistochemistry. Diagnostics (Basel) 2024; 14:200. [PMID: 38248076 PMCID: PMC10814347 DOI: 10.3390/diagnostics14020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Intracranial chondroid tumors are a heterogeneous group of neoplasms characterized by the presence of a cartilage matrix. These tumors exhibit overlapping clinical and histological features. Mutations in IDH1/2 genes serve as important diagnostic markers of tumor type, particularly chondrosarcoma. To improve the accuracy of IDH1/2 diagnostics, we compared three methods: biochip assay, real-time PCR with DNA melting analysis using TaqMan probes and sequencing (qPCR-DMA-Sanger), and immunohistochemistry (IHC). Tumor samples from 96 patients were investigated. The IDH1 mutations were detected in 34/64 (53%) chondrosarcomas; IHC detected 27/56 (48.2%) mutations, the qPCR-DMA-Sanger method 27/59 (46%) mutations, and the biochip assay revealed 29/60 (48.3%) mutations. The detection of IDH1 mutations in chordoma (2/15) and osteosarcoma (2/7) suggested the need for a revised diagnosis. In benign tumors, IDH1 mutations were present in chondroma (4/6), but absent in chondromyxoid fibroma (0/4). The most frequent IDH1 mutations were R132C (60%), R132L, and R132G (13.5% each), R132H (8%), and R132S (5%). The concordance between the biochip assay and IHC was 90%, between IHC and PCR-DMA-Sanger 83%, and between biochip assay and qPCR-DMA-Sanger was 98%, respectively. No IDH2 mutations were found. The use of independent diagnostic methods may improve the detection of IDH-mutant specimens in chondroid tumors.
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Affiliation(s)
- Vyacheslav Varachev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (V.V.); (D.G.); (A.Z.)
| | - Anastasia Shekhtman
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 125047 Moscow, Russia;
- Russian Children’s Clinical Hospital, N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, 119571 Moscow, Russia;
| | - Dmitrii Guskov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (V.V.); (D.G.); (A.Z.)
| | - Dmitrii Rogozhin
- Russian Children’s Clinical Hospital, N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, 119571 Moscow, Russia;
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of the Russian Federation, 115522 Moscow, Russia
| | - Alexander Zasedatelev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (V.V.); (D.G.); (A.Z.)
| | - Tatiana Nasedkina
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (V.V.); (D.G.); (A.Z.)
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Brown NJ, Gendreau J, Kuo CC, Nguyen O, Yang C, Catapano JS, Lawton MT. Assessing survival outcomes and complication profiles following surgical excision and radiotherapy as interventions for skull base chordoma: a systematic review of operative margins and surgical approaches. J Neurooncol 2023; 165:41-51. [PMID: 37880419 DOI: 10.1007/s11060-023-04477-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Despite their precarious behavioral classification (benign and low grade on histopathology yet behaviorally malignant), great strides have been taken to improve prognostication and treatment paradigms for patients with skull base chordoma. With respect to surgical techniques, lateral transcranial (TC) approaches have traditionally been used, however endoscopic endonasal approaches (EEA) have been advocated for midline lesions. Nonetheless, due to the rarity of this pathology (0.2% of all intracranial neoplasms), investigations within the literature remain limited to small retrospective series. Furthermore, radiotherapeutic treatments investigated to date have proven largely ineffective. METHODS Accordingly, we performed a systematic review in order to profile surgical and survival outcomes for skull base chordoma. Fixed and random-effect meta-analyses were performed for categorical variables including GTR, STR, 5-year OS, 10-year OS, 5-year PFS, and 10-year PFS. Additionally, we pooled eligible studies for formal meta-analysis to compare outcomes by surgical approach (lateral versus midline). Statistical analyses were performed using R Studio 'metafor' package or Cochrane Review Manager. Furthermore, meta-analysis of pooled mortality rates and sub-analyses of operative margin and surgical complications were used to compare midline versus lateral approaches via the Mantel-Haenszel method. We considered all p-values < 0.05 to be statistically significant. RESULTS Following the systematic search and screen, 55 studies published between 1993 and 2022 reporting data for 2453 patients remained eligible for analysis. Sex distribution was comparable between males and females, with a slight predominance of male-identifying patients (0.5625 [95% CI: 0.5418; 0.3909]). Average age at diagnosis was 42.4 ± 12.5 years, while average age of treatment initiation was 43.0 ± 10.6 years. Overall, I2 value indicated notable heterogeneity across the 55 studies [I2 = 56.3% (95%CI: 44.0%; 65.9%)]. With respect to operative margins, the rate of GTR was 0.3323 [95% CI: 0.2824; 0.3909], I2 = 91.9% [95% CI: 90.2%; 93.4%], while the rate of STR was significantly higher at 0.5167 [95% CI: 0.4596; 0.5808], I2 = 93.1% [95% CI: 91.6%; 94.4%]. The most common complication was CSF leak (5.4%). In terms of survival outcomes, 5-year OS rate was 0.7113 [95% CI: 0.6685; 0.7568], I2 = 91.9% [95% CI: 90.0%; 93.5%]. 10-year OS rate was 0.4957 [95% CI: 0.4230; 0.5809], I2 = 92.3% [95% CI: 89.2%; 94.4%], which was comparable to the 5-year PFS rate of 0.5054 [95% CI: 0.4394; 0.5813], I2 = 84.2% [95% CI: 77.6%; 88.8%] and 10-yr PFS rate of 0.4949 [95% CI: 0.4075; 0.6010], I2 = 14.9% [95% CI: 0.0%; 87.0%]. There were 55 reported deaths for a perioperative mortality rate of 2.5%. The relative risk for mortality in the midline group versus the lateral approach group did not indicate any substantial difference in survival according to laterality of approach (-0.93 [95% CI: -1.03, -0.97], I2 = 95%, (p < 0.001). CONCLUSION Overall, these results indicate good 5-year survival outcomes for patients with skull base chordoma; however, 10-year prognosis for skull base chordoma remains poor due to its radiotherapeutic resistance and high recurrence rate. Furthermore, mortality rates among patients undergoing midline versus lateral skull base approaches appear to be equivocal.
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Affiliation(s)
- Nolan J Brown
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Cathleen C Kuo
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Oanh Nguyen
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Chenyi Yang
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, 2910 North Third Avenue, Phoenix, AZ, 85013, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, 2910 North Third Avenue, Phoenix, AZ, 85013, USA.
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9
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Tang DM, Cutri RM, Wu AW, Patil C, Zumsteg ZS. Proton Therapy for Skull Base Chondrosarcoma. J Neurol Surg Rep 2023; 84:e144-e145. [PMID: 38026146 PMCID: PMC10659847 DOI: 10.1055/a-2192-5775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Chondrosarcoma is a type of an endochondral bone malignancy that is primarily treated surgically with radiation therapy used in the adjuvant setting or in cases of unresectable disease. Proton therapy has potential advantages compared with traditional photon therapy for the treatment of tumors in close proximity to critical structures due to the theoretic lower exit dose. Studies have shown improved survival in patients with skull base chondrosarcoma who undergo proton therapy. However, there is a lack of randomized data. Further studies are needed to define the role of proton therapy in the treatment of skull base chondrosarcoma.
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Affiliation(s)
- Dennis M. Tang
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Raffaello M. Cutri
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Arthur W. Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Chirag Patil
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Zachary S. Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, United States
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10
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Hall J, Yanagihara TK, Wang TJC. Commentary: Fractionated Radiotherapy After Gross Total Resection of Clival Chordoma: A Systematic Review of Survival Outcomes. Neurosurgery 2023; 93:e19-e20. [PMID: 36861997 DOI: 10.1227/neu.0000000000002445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Jacob Hall
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ted K Yanagihara
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York, USA
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11
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Gendreau JL, Hameed NUF, Jimenez A, Chakravarti S, Mehkri Y, Mukherjee D. Fractionated Radiotherapy After Gross Total Resection of Clival Chordoma: A Systematic Review of Survival Outcomes. Neurosurgery 2023; 93:257-266. [PMID: 36826997 DOI: 10.1227/neu.0000000000002418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Current treatment guidelines for clival chordomas recommend surgical resection followed by high-dose radiotherapy (RT). However, in patients in whom gross total resection (GTR) is achieved, the benefits of additional RT remain unclear. OBJECTIVE To investigate whether RT offers any benefit to progression-free survival (PFS) in patients undergoing GTR of clival chordoma by performing a systematic review of all currently published literature. METHODS A total of 5 databases were searched to include all studies providing data on GTR ± RT for clival chordomas (January 1990-June 2021). Qualitative assessment was performed with Newcastle-Ottawa Scale guidelines for assessing quality of nonrandomized studies. Statistical analysis using individualized patient data of PFS was performed. RESULTS The systematic search yielded 2979 studies, weaned to 22 full-text articles containing 108 patients. All patients underwent GTR of clival chordoma, with 46 (43%) patients receiving adjuvant RT. Mean PFS for RT patients was 31.09 months (IQR: 12.25-37.75) vs 54.92 months (IQR: 14.00-85.75) in non-RT patients. Overall, RT did not increase PFS (HR 0.320, P = .069) to a value that achieved statistical significance. Stratifying by photon therapy vs particle beam therapy yielded no statistically significant benefit for particle beam therapy for PFS ( P = .300). Of patients with age ≥65 years, RT did not improve outcomes to statistical significance for PFS (HR 0.450, P = .481). Patients age ≥65 years had lower PFS on both bivariate analysis (HR 3.708, P = .007) and multivariate analysis (HR 3.322, P = .018). CONCLUSION After achieving GTR of clival chordoma, fractionated RT offers unclear benefit upon survival outcomes.
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Affiliation(s)
- Julian L Gendreau
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - N U Farrukh Hameed
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adrian Jimenez
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yusuf Mehkri
- Department of Neurosurgery, University of Florida School of Medicine, Jacksonville, Florida, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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12
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Ucisik FE, Huell D, Choi J, Gidley PW, DeMonte F, Hanna EY, Learned KO. Post-Treatment Imaging Evaluation of the Skull Base. Semin Roentgenol 2023; 58:217-236. [PMID: 37507165 DOI: 10.1053/j.ro.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/09/2023] [Accepted: 03/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- F Eymen Ucisik
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Derek Huell
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeanie Choi
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Kim O Learned
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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13
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Passeri T, Champagne PO, Giammattei L, Abbritti R, Cartailler J, Calugaru V, Feuvret L, Guichard JP, Polivka M, Adle-Biassette H, Mammar H, Bresson D, Herman P, Mandonnet E, George B, Froelich S. Management strategies in clival and craniovertebral junction chordomas: a 29-year experience. J Neurosurg 2023; 138:1640-1652. [PMID: 36272118 DOI: 10.3171/2022.8.jns221621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chordomas represent one of the most challenging subsets of skull base and craniovertebral junction (CVJ) tumors to treat. Despite extensive resection followed by proton-beam radiation therapy, the recurrence rate remains high, highlighting the importance of developing efficient treatment strategies. In this study, the authors present their experience in treating clival and CVJ chordomas over a 29-year period. METHODS The authors conducted a retrospective study of clival and CVJ chordomas that were surgically treated at their institution from 1991 to 2020. This study focuses on three aspects of the management of these tumors: the factors influencing the extent of resection (EOR), the predictors of survival, and the outcomes of the endoscopic endonasal approaches (EEAs) compared with open approaches (OAs). RESULTS A total of 265 surgical procedures were performed in 210 patients, including 123 OAs (46.4%) and 142 EEAs (53.6%). Tumors that had an intradural extension (p = 0.03), brainstem contact (p = 0.005), cavernous sinus extension (p = 0.004), major artery encasement (p = 0.01), petrous apex extension (p = 0.003), or high volume (p = 0.0003) were significantly associated with a lower EOR. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 52.1% and 75.1%, respectively. Gross-total resection and Ki-67 labeling index < 6% were considered to be independent prognostic factors of longer PFS (p = 0.0005 and p = 0.003, respectively) and OS (p = 0.02 and p = 0.03, respectively). Postoperative radiation therapy correlated independently with a longer PFS (p = 0.006). Previous surgical treatment was associated with a lower EOR (p = 0.01) and a higher rate of CSF leakage after EEAs (p = 0.02) but did not have significantly lower PFS and OS compared with primary surgery. Previously radiation therapy correlated with a worse outcome, with lower PFS and OS (p = 0.001 and p = 0.007, respectively). EEAs were more frequently used in patients with upper and middle clival tumors (p = 0.002 and p < 0.0001, respectively), had a better rate of EOR (p = 0.003), and had a lower risk of de novo neurological deficit (p < 0.0001) compared with OAs. The overall rate of postoperative CSF leakage after EEAs was 14.8%. CONCLUSIONS This large study showed that gross-total resection should be attempted in a multidisciplinary skull base center before providing radiation therapy. EEAs should be considered as the gold-standard approach for upper/middle clival lesions based on the satisfactory surgical outcome, but OAs remain important tools for large complex chordomas.
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Affiliation(s)
| | | | | | | | | | - Valentin Calugaru
- 3Department of Radiation Oncology, Institut Curie-Proton Beam Therapy Center, Orsay; and
| | - Loïc Feuvret
- 3Department of Radiation Oncology, Institut Curie-Proton Beam Therapy Center, Orsay; and
- 4Department of Radiation Oncology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | | | | | - Hamid Mammar
- 3Department of Radiation Oncology, Institut Curie-Proton Beam Therapy Center, Orsay; and
| | | | - Philippe Herman
- 7Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris
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14
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Gendreau J, Jimenez A, Lozinsky S, Zenonos G, Gardner P, Raza S, Dea N, Gokaslan Z, Choby G, Van Gompel J, Redmond K, Gallia G, Bettegowda C, Rowan N, Kuo CC, Mukherjee D. Radiotherapy After Gross Total Resection of Skull Base Chordoma: A Surveillance, Epidemiology, and End Results Database Analysis of Survival Outcomes. World Neurosurg 2023; 172:e68-e76. [PMID: 36509323 DOI: 10.1016/j.wneu.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Skull base chordoma is a rare and locally destructive malignancy which presents unique therapeutic challenges. While achieving gross total resection (GTR) confers the greatest survival advantage, the role of adjuvant radiotherapy (RT) for patients who receive GTR remains unclear in the absence of prospective trials. Here, we aim to assess the effect of RT on survival outcomes in skull base chordoma patients who receive GTR by utilizing the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with diagnostic, primary site, and resection codes specific for chordoma, skull base, and GTR, respectively, were queried in the SEER database (2000-2018). Kaplan-Meier curves (log-rank test) were constructed and Cox proportional hazards models were used to assess survival outcomes. RESULTS A total of 115 skull base chordomas undergoing GTR were identified, of which 37 (32%) received no RT and 78 (68%) received RT. Median follow-up was 55.00 months (range: 0.00-227.00). Overall survival (OS) of patients with GTR was 85% and 70% at 5 and 10 years, respectively. Multivariate Cox proportional hazard analysis among chordoma patients undergoing GTR found age ≥65 (P < 0.01) was associated with poorer OS outcomes. RT appeared to trend toward offering benefit in terms of OS in patients after GTR, however this did not achieve statistical significance in the adjusted model (HR = 0.51, CI = 0.23-1.16, P = 0.09). When comparing, disease-specific survival was also not improved in patients undergoing RT (HR = 0.58, CI = 0.23-1.46, P = 0.25). CONCLUSIONS It remains unclear whether RT after GTR of chordoma improved survival outcomes among SEER database patients.
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Affiliation(s)
- Julian Gendreau
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Adrian Jimenez
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Georgios Zenonos
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul Gardner
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaan Raza
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolas Dea
- Department of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Ziya Gokaslan
- Department of Neurosurgery, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie Van Gompel
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin Redmond
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Gary Gallia
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Rowan
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cathleen C Kuo
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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15
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Tubin S, Fossati P, Mock U, Lütgendorf-Caucig C, Flechl B, Pelak M, Georg P, Fussl C, Carlino A, Stock M, Hug E. Proton or Carbon Ion Therapy for Skull Base Chordoma: Rationale and First Analysis of a Mono-Institutional Experience. Cancers (Basel) 2023; 15:cancers15072093. [PMID: 37046752 PMCID: PMC10093149 DOI: 10.3390/cancers15072093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Skull base chordomas are radio-resistant tumors that require high-dose, high-precision radiotherapy, as can be delivered by particle therapy (protons and carbon ions). We performed a first clinical outcome analysis of particle therapy based on the initial 4-years of operation. Methods: Between August 2017 and October 2021, 44 patients were treated with proton (89%) or carbon ion therapy (11%). Prior gross total resection had been performed in 21% of lesions, subtotal resection in 57%, biopsy in 12% and decompression in 10%. The average prescription dose was 75.2 Gy RBE in 37 fractions for protons and 66 Gy RBE in 22 fractions for carbon ions. Results: At a median follow-up of 34.3 months (range: 1–55), 2-, and 3-year actuarial local control rates were 95.5% and 90.9%, respectively. The 2-, and 3-year overall and progression-free survival rates were 97.7%, 93.2%, 95.5% and 90.9%, respectively. The tumor volume at the time of particle therapy was highly predictive of local failure (p < 0.01), and currently, there is 100% local control in patients with tumors < 49 cc. No grade ≥3 toxicities were observed. There was no significant difference in outcome or side effect profile seen for proton versus carbon ion therapy. Five patients (11.4%) experienced transient grade ≤2 radiation-induced brain changes. Conclusions: The first analysis suggests the safety and efficacy of proton and carbon ion therapy at our center. The excellent control of small to mid-size chordomas underlines the effectiveness of particle therapy and importance of upfront maximum debulking of large lesions.
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Affiliation(s)
- Slavisa Tubin
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
- Correspondence:
| | - Piero Fossati
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
| | - Ulrike Mock
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
| | | | - Birgit Flechl
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
| | - Maciej Pelak
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
| | - Petra Georg
- Klinische Abteilung für Strahlentherapie—Radioonkologie, Mitterweg 10, 3500 Krems an der Donau, Austria
| | - Christoph Fussl
- Universitätsklinik für Radiotherapie und Radio-Onkologie der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Antonio Carlino
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
| | - Markus Stock
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
| | - Eugen Hug
- MedAustron Center for Ion Therapy, Marie Curie Strasse 5, 2700 W. Neustadt, Austria
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16
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Gersey ZC, Zenonos GA, Gardner PA. Malignant Brain and Spinal Tumors Originating from Bone or Cartilage. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:477-506. [PMID: 37452950 DOI: 10.1007/978-3-031-23705-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Malignant bone tumors affecting the brain and spine are a rare and exceedingly difficult-to-treat group of diseases. Most commonly consisting of chordoma and chondrosarcoma, these tumors also include giant-cell tumors and osteosarcomas. This chapter will cover the background, epidemiology, genetics, molecular biology, histopathology, radiographic features, clinical manifestations, therapeutic approaches, and clinical management of each entity.
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Affiliation(s)
- Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul A Gardner
- UPMC Center for Cranial Base Surgery, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA.
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17
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Passeri T, Dahmani A, Masliah-Planchon J, El Botty R, Courtois L, Vacher S, Marangoni E, Nemati F, Roman-Roman S, Adle-Biassette H, Mammar H, Froelich S, Bièche I, Decaudin D. In vivo efficacy assessment of the CDK4/6 inhibitor palbociclib and the PLK1 inhibitor volasertib in human chordoma xenografts. Front Oncol 2022; 12:960720. [PMID: 36505864 PMCID: PMC9732546 DOI: 10.3389/fonc.2022.960720] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Management of advanced chordomas remains delicate considering their insensitivity to chemotherapy. Homozygous deletion of the regulatory gene CDKN2A has been described as the most frequent genetic alteration in chordomas and may be considered as a potential theranostic marker. Here, we evaluated the tumor efficacy of the CDK4/6 inhibitor palbociclib, as well as the PLK1 inhibitor volasertib, in three chordoma patient-derived xenograft (PDX) models to validate and identify novel therapeutic approaches. Methods From our chordoma xenograft panel, we selected three models, two of them harboring a homozygous deletion of CDKN2A/2B genes, and the last one a PBRM1 pathogenic variant (as control). For each model, we tested the palbociclib and volasertib drugs with pharmacodynamic studies together with RT-PCR and RNAseq analyses. Results For palbociclib, we observed a significant tumor response for one of two models harboring the deletion of CDKN2A/2B (p = 0.02), and no significant tumor response in the PBRM1-mutated PDX; for volasertib, we did not observe any response in the three tested models. RT-PCR and RNAseq analyses showed a correlation between cell cycle markers and responses to palbociclib; finally, RNAseq analyses showed a natural enrichment of the oxidative phosphorylation genes (OxPhos) in the palbociclib-resistant PDX (p = 0.02). Conclusion CDK4/6 inhibition appears as a promising strategy to manage advanced chordomas harboring a loss of CDKN2A/2B. However, further preclinical studies are strongly requested to confirm it and to understand acquired or de novo resistance to palbociclib, in the peculiar view of a targeting of the oxidative phosphorylation genes.
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Affiliation(s)
- Thibault Passeri
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
- Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France
| | - Ahmed Dahmani
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | | | - Rania El Botty
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | - Laura Courtois
- Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France
| | - Sophie Vacher
- Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France
| | - Elisabetta Marangoni
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | - Fariba Nemati
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | - Sergio Roman-Roman
- Department of Translational Research, Institut Curie, University of Paris Saclay, Paris, France
| | - Homa Adle-Biassette
- Department of Pathology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France
| | - Hamid Mammar
- Department of Radiotherapy - Proton Therapy Center, Institut Curie, Paris-Saclay University, Orsay, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France
| | - Ivan Bièche
- Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France
| | - Didier Decaudin
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
- Department of Medical Oncology, Institut Curie, Paris, France
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18
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Park M, Park I, Hong CK, Kim SH, Cha YJ. Differences in stromal component of chordoma are associated with contrast enhancement in MRI and differential gene expression in RNA sequencing. Sci Rep 2022; 12:16504. [PMID: 36192442 PMCID: PMC9529962 DOI: 10.1038/s41598-022-20787-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Chordoma is a malignant bone neoplasm demonstrating notochordal differentiation and it frequently involves axial skeleton. Most of chordomas are conventional type with varying amount of myxoid stroma. Previously known prognostic factors for conventional chordoma are not specific for chordoma: old age, metastasis, tumor extent, and respectability. Here, we aimed to investigate the histologic, radiologic, and transcriptomic differences in conventional chordoma based on the stromal component. A total of 45 patients diagnosed with conventional chordoma were selected between May 2011 and March 2020 from a single institution. Electronic medical records, pathology slides, and pretreatment magnetic resonance imaging (MRI) scans were reviewed. Of the 45 patients, ten cases (4 stroma-rich and 6 stroma-poor tumor) were selected for RNA sequencing, and available cases in the remainder were used for measuring target gene mRNA expression with qPCR for validation. Differential gene expression and gene set analysis were performed. Based on histologic evaluation, there were 25 (55.6%) stroma-rich and 20 (44.4%) stroma-poor cases. No clinical differences were found between the two groups. Radiologically, stroma-rich chordomas showed significant signal enhancement on MRI (72.4% vs 27.6%, p = 0.002). Upregulated genes in stroma-rich chordomas were cartilage-, collagen/extracellular matrix-, and tumor metastasis/progression-associated genes. Contrarily, tumor suppressor genes were downregulated in stroma-rich chordomas. On survival analysis, Kaplan–Meier plot was separated that showed inferior outcome of stroma-rich group, although statistically insignificant. In conclusion, the abundant stromal component of conventional chordoma enhanced well on MRI and possibly contributed to the biological aggressiveness that supported by transcriptomic characteristics. Further extensive investigation regarding radiologic-pathologic-transcriptomic correlation in conventional chordoma in a larger cohort could verify additional clinical significance.
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Affiliation(s)
- Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Inho Park
- Center for Precision Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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19
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Bishop AJ, Amini B, Lin H, Raza SM, Patel S, Grosshans DR, Ghia A, Farooqi A, Guadagnolo BA, Mitra D, Akdemir KC, Lazar AJ, Wang WL, Alvarez-Breckenridge C, Bird J, Rhines LD, Somaiah N, Conley AP. Immune Checkpoint Inhibitors Have Clinical Activity in Patients With Recurrent Chordoma. J Immunother 2022; 45:374-378. [PMID: 35943386 PMCID: PMC9452485 DOI: 10.1097/cji.0000000000000431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study is to evaluate the outcomes and tolerance of immune checkpoint inhibitors (ICIs) for patients with recurrent chordoma. We reviewed the records of 17 patients with recurrent chordomas who received ICIs for progressing disease as part of their treatment between 2016 and 2020. Response was assessed using response evaluation criteria in solid tumors 1.1 criteria. The Kaplan-Meier method was used to estimate the duration of response, progression-free survival (PFS), and overall survival (OS). Clinical benefit was defined as having stable disease (SD), a partial response, or a complete response. The median follow-up from the start of ICIs was 29 months [interquartile range (IQR): 13-35 m]. The majority received pembrolizumab (n=9, 53%), and the median number of cycles delivered was 8 (IQR: 7-12). The 1-year OS was 87%, and the 1-year PFS was 56% with a median PFS of 14 months (95% CI, 5-17 mo). After ICI initiation, most patients (n=15, 88%) had clinical benefit consisting of a complete response (n=1, 6%), partial response (n=3, 18%), and stable disease (n=11, 65%). Among all responders (n=15), the median duration of response was 12 months. Toxicities were limited: 2 (12%) patients having grade 3/4 immune-related toxicities (colitis, grade 3; myocarditis, grade 4). We observed a high rate of clinical benefit and favorable durability from ICI use for patients with recurrent chordoma. These data provide support for the integration of ICIs as a standard first-line systemic therapy option for patients with recurrent chordoma. Prospective studies are warranted to further evaluate efficacy and enhance response rates.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Justin Bird
- Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Tian K, Ma J, Wang K, Li D, Zhang J, Wang L, Wu Z. PTEN is recognized as a prognostic-related biomarker and inhibits proliferation and invasiveness of skull base chordoma cells. Front Surg 2022; 9:1011845. [PMID: 36211273 PMCID: PMC9537766 DOI: 10.3389/fsurg.2022.1011845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This work aimed to examine the function of phosphatase and tensin homologue deleted on chromosome 10 (PTEN) in skull base chordoma (SBC) at the clinical and cellular levels. Methods Totally 65 paraffin-embedded and 86 frozen specimens from 96 patients administered surgery were analyzed. Immunohistochemical staining and quantitative real-time polymerase chain reaction were performed, and the associations of PTEN expression with clinical features were assessed. At the cellular level, PTEN was knocked down by the siRNA approach in the UCH-1 cell line, and cell proliferation and invasion were detected by the CCK-8 and migration assays, respectively. Results At the protein level, PTEN expression was increased in non-bone-invasive tumor samples in comparison with bone-invasive specimens (p = 0.025), and elevated in soft SBCs in comparison with hard tumors (p = 0.017). Increased PTEN protein expression was associated with decreased risk of tumor progression (p = 0.002; hazard ratio = 0.981, 95% confidence interval: 0.969–0.993). At the gene expression level, the cut-off value was set at 10.5 after ROC curve analysis, and SBC specimens were divided into two groups: PTEN high group, ΔCt value below 10.5; PTEN low group, ΔCt value above 10.5. In multivariate regression analysis of PFS, the risk of tumor progression was increased in PTEN low group tumors in comparison with PTEN high group SBCs (p = 0.006). In the CCK-8 assay, in comparison with control cells, PTEN knockdown cells had increased absorbance, suggesting elevated cell proliferation rate. In the invasion assay, the number of tumor cells penetrating into the lower chamber was significantly increased in the PTEN knockdown group compared with control cells. Conclusions Decreased PTEN expression in SBC, at the protein and gene levels, is associated with reduced PFS. PTEN knockdown in chordoma cells led to enhanced proliferation and invasiveness.
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Affiliation(s)
| | | | | | | | | | | | - Zhen Wu
- Correspondence: Liang Wang Zhen Wu
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21
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Revisitation of imaging features of skull base chondrosarcoma in comparison to chordoma. J Neurooncol 2022; 159:581-590. [PMID: 35882753 DOI: 10.1007/s11060-022-04097-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Pre-surgical diagnosis of skull base chondrosarcoma (SBC) is often challenging due to the resemblance to chordoma. The goal of this study was to develop an optimal method for predicting SBC diagnosis. METHODS This retrospective study included patients with histologically diagnosed SBC and skull base chordoma. Their clinical and radiologic features were compared, and the predictive factors of SBC were examined. RESULTS Forty-one patients with SBC and 41 with chordoma were included. Most SBCs exhibited hypointensity (25, 64.1%) or isointensity (12, 30.8%) on T1-weighted images, and hyperintensity (34, 87.1%) or mixed intensity (5, 12.8%) on T2-weighted images. MRI contrast enhancement was usually avid or fair (89.7%) with "arabesque"-like pattern (41.0%). The lateral/paramidline location was more common in SBC than in chordoma (85.4% vs. 9.8%; P < 0.01), while midline SBCs (14.6%) were also possible. Multivariate analysis demonstrated that higher apparent diffusion coefficient (ADC) value (unit odds ratio 1.01; 95% confidence interval 1.00-1.02; P < 0.01) was associated with an SBC diagnosis. An ADC value of ≥ 1750 × 10-6 mm2/s demonstrated a strong association with an SBC diagnosis (odds ratio 5.89 × 102; 95% confidence interval 51.0-6.80 × 103; P < 0.01) and yielded a sensitivity of 93.9%, specificity of 97.4%, positive predictive value of 96.9%, and negative predictive value of 95.0%. CONCLUSION The ADC-based method is helpful in distinguishing SBC from chordoma and readily applicable in clinical practice. The prediction accuracy increases when other characteristics of SBC, such as non-midline location and arabesque-like enhancement, are considered together.
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22
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Liu Q, Ren J, Feng H. Nomograms for predicting long-term overall survival and cancer-specific survival in chordoma: a population-based study. Future Oncol 2022; 18:2687-2699. [PMID: 35818980 DOI: 10.2217/fon-2022-0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: The aim of this study was to develop two predictive models to predict overall survival (OS) and cancer-specific survival (CSS) in chordoma patients. Methods: We searched for independent prognostic factors by using univariate and multivariate Cox regression analyses. The prediction model of OS and CSS of chordoma patients was constructed by using the screened factors. Results: The study enrolled 362 chordoma patients. Cox regression analysis showed that disease stage, age, surgery, marital status and tumor size are independent influencing factors of OS and CSS in chordoma patients. After testing, the prediction model constructed in this study has good performance. Conclusion: Two predictive models were successfully constructed and validated for chordoma patients' OS and CSS.
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Affiliation(s)
- Qingqing Liu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital,Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Jie Ren
- Shanxi Cancer Hospital,Taiyuan, 030000, China
| | - Haoyu Feng
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital,Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
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23
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Yamazawa E, Takahashi S, Shin M, Tanaka S, Takahashi W, Nakamoto T, Suzuki Y, Takami H, Saito N. MRI-Based Radiomics Differentiates Skull Base Chordoma and Chondrosarcoma: A Preliminary Study. Cancers (Basel) 2022; 14:cancers14133264. [PMID: 35805036 PMCID: PMC9265125 DOI: 10.3390/cancers14133264] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary In this study, we created a novel MRI-based machine learning model to differentiate skull base chordoma and chondrosarcoma with multiparametric signatures. While these tumors share common radiographic characteristics, clinical behavior is distinct. Therefore, distinguishing these tumors before initial surgical intervention would be useful, potentially impacting the surgical strategy. Although there are some limitations, such as the risk of overfitting and the lack of an extramural cohort for truly independent final validation, our machine learning model distinguishing chordoma from chondrosarcoma yielded superior diagnostic accuracy to that achieved by 20 board-certified neurosurgeons. Abstract Chordoma and chondrosarcoma share common radiographic characteristics yet are distinct clinically. A radiomic machine learning model differentiating these tumors preoperatively would help plan surgery. MR images were acquired from 57 consecutive patients with chordoma (N = 32) or chondrosarcoma (N = 25) treated at the University of Tokyo Hospital between September 2012 and February 2020. Preoperative T1-weighted images with gadolinium enhancement (GdT1) and T2-weighted images were analyzed. Datasets from the first 47 cases were used for model creation, and those from the subsequent 10 cases were used for validation. Feature extraction was performed semi-automatically, and 2438 features were obtained per image sequence. Machine learning models with logistic regression and a support vector machine were created. The model with the highest accuracy incorporated seven features extracted from GdT1 in the logistic regression. The average area under the curve was 0.93 ± 0.06, and accuracy was 0.90 (9/10) in the validation dataset. The same validation dataset was assessed by 20 board-certified neurosurgeons. Diagnostic accuracy ranged from 0.50 to 0.80 (median 0.60, 95% confidence interval 0.60 ± 0.06%), which was inferior to that of the machine learning model (p = 0.03), although there are some limitations, such as the risk of overfitting and the lack of an extramural cohort for truly independent final validation. In summary, we created a novel MRI-based machine learning model to differentiate skull base chordoma and chondrosarcoma from multiparametric signatures.
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Affiliation(s)
- Erika Yamazawa
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (E.Y.); (H.T.); (N.S.)
| | - Satoshi Takahashi
- RIKEN Center for Advanced Intelligence Project, 2-1 Hirosawa, Wako 351-0198, Japan;
- Division of Medical AI Research and Development, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Masahiro Shin
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (E.Y.); (H.T.); (N.S.)
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan
- Correspondence: (M.S.); (S.T.); Tel.: +81-3-3964-1211 (M.S.); +81-3-3815-5411 (S.T.)
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (E.Y.); (H.T.); (N.S.)
- Correspondence: (M.S.); (S.T.); Tel.: +81-3-3964-1211 (M.S.); +81-3-3815-5411 (S.T.)
| | - Wataru Takahashi
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (W.T.); (T.N.); (Y.S.)
| | - Takahiro Nakamoto
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (W.T.); (T.N.); (Y.S.)
- Department of Biological Science and Engineering, Faculty of Health Sciences, Hokkaido University Kita 12, Nishi 5, Kita-ku, Sapporo-shi 060-0808, Japan
| | - Yuichi Suzuki
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (W.T.); (T.N.); (Y.S.)
| | - Hirokazu Takami
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (E.Y.); (H.T.); (N.S.)
| | - Nobuhito Saito
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (E.Y.); (H.T.); (N.S.)
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24
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Matsuoka M, Onodera T, Yokota I, Iwasaki K, Hishimura R, Suzuki Y, Iwata A, Kondo E, Iwasaki N. Does Primary Tumor Resection in Patients with Metastatic Primary Mobile Vertebral Column Sarcoma Improve Survival? World Neurosurg 2022; 163:e647-e654. [PMID: 35439623 DOI: 10.1016/j.wneu.2022.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary mobile vertebral column sarcoma is an exceedingly rare malignancy. Although primary tumor resection has been reported to prolong survival in patients with metastatic bone sarcoma, whether primary tumor resection in patients with advanced primary mobile vertebral column sarcoma is associated with survival remains unclear owing to the rarity of this pathological entity. METHODS Using the Surveillance, Epidemiology, and End Results database, 182 patients with metastatic primary mobile vertebral column sarcoma were identified between 1983 and 2015. Of the 182 patients enrolled, 101 patients (55%) underwent primary tumor resection (Surgery group) and 81 patients (45%) did not undergo resection (No Surgery group). To account for imbalances in the basic characteristics of patients between groups, propensity score matching was performed. Survival analysis was performed by weighted Cox proportional hazards modeling to calculate hazard ratios. RESULTS After adjusting for patient background characteristics, 138 patients were included for the analysis (Surgery group: 69 patients; No Surgery group: 69 patients). The Surgery group did not show improved cancer-specific survival (hazard ratio = 0.73, 95% CI 0.49-1.10). Similarly, the Surgery group did not show improved overall survival compared with the No Surgery group (hazard ratio = 0.80, 95% CI 0.55-1.16). CONCLUSIONS To our knowledge, this is the first study to indicate that surgical resection for advanced primary mobile vertebral column sarcoma does not have a positive impact on survival.
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Affiliation(s)
- Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Hokkaido, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akira Iwata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
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Holtzman AL, Bates JE, Morris CG, Rutenberg MS, Indelicato DJ, Tavanaiepour D, Mendenhall WM. Impact of Type of Treatment Center and Access to Care on Mortality and Survival for Skull Base Chordoma and Chondrosarcoma. Skull Base Surg 2022; 83:328-338. [DOI: 10.1055/s-0040-1722228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/04/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Introduction In adults with skull base chordoma or chondrosarcoma, the impact of treatment center and access to care have not been well described in regard to perioperative mortality and survival.
Methods A query of the National Cancer Database (NCDB) and review of 1,102 adults—488 with chordomas and 614 with chondrosarcomas—was performed. The Kaplan–Meier's product limit method and chi-square analysis, respectively, assessed overall survival and 30-day (30D) and 90-day (90D) mortalities.
Results For 925 patients who had surgery and available mortality data, the 30D and 90D mortality rates were 0.9 and 1.5%. Lower education level (p = 0.0185) and treatment at a nonacademic facility (p = 0.016) were associated with increased risk of 90-day mortality. Median follow-up was 52 months and analysis was dichotomized by histology. For those with skull base chordoma, patients from a larger metro size (p = 0.002), age below the median 52 years (p ≤ 0.001), and private insurance (<0.001) were associated with prolonged survival, whereas for skull base chondrosarcoma, the factors were treatment at an academic medical center (p = 0.001), high-volume center (p = 0.007), age below the median 52 years (p ≤ 0.001), higher income (p = 0.043), higher education (p = 0.017), and private insurance (p ≤ 0.001). Comparing high-, medium-, and low-volume centers, high-volume centers were most likely to be academic, deliver radiotherapy, escalate doses >70 Gy, and utilize proton radiotherapy consistent across both disease subsets.
Conclusion Higher educational attainment and treatment at an academic facility were associated with decreased 90D mortality for patients with skull base chordoma and chondrosarcoma. For those with skull base chordoma, larger metro size, younger age, and private insurance were associated with prolonged survival; for those with chondrosarcoma, it was treatment at a high-volume or academic medical center, younger age, higher income or education, and private insurance.
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Affiliation(s)
- Adam L. Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - James E. Bates
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Michael S. Rutenberg
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Daniel J. Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Daryoush Tavanaiepour
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
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26
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Vuong HG, Dunn IF. Chondrosarcoma and Chordoma of the Skull Base and Spine: Implication of Tumor Location on Patient Survival. World Neurosurg 2022; 162:e635-e639. [PMID: 35339711 DOI: 10.1016/j.wneu.2022.03.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chondrosarcoma and chordoma are often grouped together because of their similar anatomic locations, clinical presentations, histopathological and radiological findings, and growth patterns. In the present study, we investigated the clinical and prognostic differences of chondrosarcomas and chordomas of the skull base and spine. METHODS We accessed the Surveillance, Epidemiology, and End Results database to search for patients from 2000 to 2018 with chondrosarcomas and chordomas of the skull base and spine for inclusion in the present study. RESULTS We included 1346 and 1536 cases of chondrosarcoma and chordoma for analysis, respectively. Chondrosarcomas of the cranial base and spine were seen in younger patients and were associated with a larger tumor size compared with chordomas. Among the tumors of the skull base, chondrosarcomas were more common in women, with a male predominance found for chordomas. We also observed a male predilection for both spinal chondrosarcomas and chordomas. Distinct metastatic patterns were found for chondrosarcomas versus chordomas, and spinal chondrosarcomas showed a greater risk of distant metastases at presentation compared with spinal chordomas. Cranial base chondrosarcomas were associated with superior outcomes compared with chordomas. However, we demonstrated an opposite survival pattern for spinal chondrosarcomas and chordomas. CONCLUSIONS Chondrosarcomas and chordomas have divergent clinical manifestations and prognoses depending on the anatomic location.
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Affiliation(s)
- Huy Gia Vuong
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.
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27
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Passeri T, Dahmani A, Masliah-Planchon J, Naguez A, Michou M, El Botty R, Vacher S, Bouarich R, Nicolas A, Polivka M, Franck C, Schnitzler A, Némati F, Roman-Roman S, Bourdeaut F, Adle-Biassette H, Mammar H, Froelich S, Bièche I, Decaudin D. Dramatic In Vivo Efficacy of the EZH2-Inhibitor Tazemetostat in PBRM1-Mutated Human Chordoma Xenograft. Cancers (Basel) 2022; 14:cancers14061486. [PMID: 35326637 PMCID: PMC8946089 DOI: 10.3390/cancers14061486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Chordomas are rare bone tumors characterized by a high recurrence rate. Presently, no medical treatment is available for advanced diseases due to the lack of molecular data and preclinical models. The current study showed the establishment and characterization of the largest panel chordoma xenografts, allowing pharmacological studies. In one PBRM1-mutated model, we demonstrated a strong therapeutic efficacy of the EZH2-inhibitor tazemetostat, encouraging further research on EZH2-inhibitors in chordomas. Abstract Chordomas are rare neoplasms characterized by a high recurrence rate and a poor long-term prognosis. Considering their chemo-/radio-resistance, alternative treatment strategies are strongly required, but their development is limited by the paucity of relevant preclinical models. Mutations affecting genes of the SWI/SNF complexes are frequently found in chordomas, suggesting a potential therapeutic effect of epigenetic regulators in this pathology. Twelve PDX models were established and characterized on histological and biomolecular features. Patients whose tumors were able to grow into mice had a statistically significant lower progression-free survival than those whose tumors did not grow after in vivo transplantation (p = 0.007). All PDXs maintained the same histopathological features as patients’ tumors. Homozygous deletions of CDKN2A/2B (58.3%) and PBRM1 (25%) variants were the most common genomic alterations found. In the tazemetostat treated PDX model harboring a PBRM1 variant, an overall survival of 100% was observed. Our panel of chordoma PDXs represents a useful preclinical tool for both pharmacologic and biological assessments. The first demonstration of a high antitumor activity of tazemetostat in a PDX model harboring a PBRM1 variant supports further evaluation for EZH2-inhibitors in this subgroup of chordomas.
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Affiliation(s)
- Thibault Passeri
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, 75005 Paris, France; (T.P.); (A.D.); (A.N.); (M.M.); (R.E.B.); (F.N.)
- Department of Genetics, Institut Curie, University of Paris Saclay, 75005 Paris, France; (J.M.-P.); (S.V.); (C.F.); (A.S.); (I.B.)
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, 75010 Paris, France;
| | - Ahmed Dahmani
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, 75005 Paris, France; (T.P.); (A.D.); (A.N.); (M.M.); (R.E.B.); (F.N.)
| | - Julien Masliah-Planchon
- Department of Genetics, Institut Curie, University of Paris Saclay, 75005 Paris, France; (J.M.-P.); (S.V.); (C.F.); (A.S.); (I.B.)
| | - Adnan Naguez
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, 75005 Paris, France; (T.P.); (A.D.); (A.N.); (M.M.); (R.E.B.); (F.N.)
| | - Marine Michou
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, 75005 Paris, France; (T.P.); (A.D.); (A.N.); (M.M.); (R.E.B.); (F.N.)
| | - Rania El Botty
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, 75005 Paris, France; (T.P.); (A.D.); (A.N.); (M.M.); (R.E.B.); (F.N.)
| | - Sophie Vacher
- Department of Genetics, Institut Curie, University of Paris Saclay, 75005 Paris, France; (J.M.-P.); (S.V.); (C.F.); (A.S.); (I.B.)
| | - Rachida Bouarich
- Integrated Cancer Research Site, Institut Curie, 75005 Paris, France; (R.B.); (F.B.)
| | - André Nicolas
- Department of Tumor Biology, Institut Curie, 75005 Paris, France;
| | - Marc Polivka
- Department of Pathology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, UMR 1141 Inserm, 75010 Paris, France; (M.P.); (H.A.-B.)
| | - Coralie Franck
- Department of Genetics, Institut Curie, University of Paris Saclay, 75005 Paris, France; (J.M.-P.); (S.V.); (C.F.); (A.S.); (I.B.)
| | - Anne Schnitzler
- Department of Genetics, Institut Curie, University of Paris Saclay, 75005 Paris, France; (J.M.-P.); (S.V.); (C.F.); (A.S.); (I.B.)
| | - Fariba Némati
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, 75005 Paris, France; (T.P.); (A.D.); (A.N.); (M.M.); (R.E.B.); (F.N.)
| | - Sergio Roman-Roman
- Department of Translational Research, Institut Curie, University of Paris Saclay, 75005 Paris, France;
| | - Franck Bourdeaut
- Integrated Cancer Research Site, Institut Curie, 75005 Paris, France; (R.B.); (F.B.)
| | - Homa Adle-Biassette
- Department of Pathology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, UMR 1141 Inserm, 75010 Paris, France; (M.P.); (H.A.-B.)
| | - Hamid Mammar
- Proton Therapy Center, Institut Curie, 91400 Orsay, France;
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, 75010 Paris, France;
| | - Ivan Bièche
- Department of Genetics, Institut Curie, University of Paris Saclay, 75005 Paris, France; (J.M.-P.); (S.V.); (C.F.); (A.S.); (I.B.)
| | - Didier Decaudin
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, 75005 Paris, France; (T.P.); (A.D.); (A.N.); (M.M.); (R.E.B.); (F.N.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France
- Correspondence: ; Tel.: +33-1-56-24-62-40
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Castellanos LE, Gutierrez C, Smith T, Laws ER, Iorgulescu JB. Epidemiology of common and uncommon adult pituitary tumors in the U.S. according to the 2017 World Health Organization classification. Pituitary 2022; 25:201-209. [PMID: 34580820 DOI: 10.1007/s11102-021-01189-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine the contemporary epidemiology of adult pituitary tumors with a particular focus on uncommon tumor types, using the 2017 WHO Classification of pituitary tumors. METHODS Adult patients presenting with a pituitary or sellar tumor between 2004 and 2017 were identified from the U.S. National Cancer Database, with tumor type categorized according to the 2017 WHO classification. Descriptive epidemiological statistics were evaluated and reported for all pituitary tumor types and subtypes. RESULTS 113,349 adults with pituitary tumors were identified, 53.0% of whom were female. The majority of pituitary tumors were pituitary adenomas (94.0%), followed by craniopharyngiomas (3.8%). Among pituitary adenomas, whereas 71.6% of microadenomas presented in females, only 46.7% of macroadenomas and 41.3% of giant adenomas did (p < 0.001). For craniopharyngiomas, 71.2% were adamantinomatous and 28.8% were papillary, with adamantinomatous tumors associated with Black non-Hispanic race/ethnicity (ORadj = 2.44 vs. White non-Hispanic, 99.9 %CI = 1.25-4.75, p < 0.001) in multivariable analysis. The remaining 0.7% (n = 676) of pathology-confirmed pituitary tumor types were composed of: 21% tumors of the posterior pituitary, 16% chordomas, 11% pituitary carcinomas (i.e. adenohypophyseal histology with metastasis; herein most frequently to bone), 10% meningiomas, 8% germ cell tumors, 7% hematolymphoid (largely DLBCLs), and 4% neuronal/paraneuronal (largely gangliogliomas). Pituitary carcinomas and posterior pituitary tumors demonstrated a male predilection (62.2% and 56.0%, respectively), whereas sellar meningiomas predominated in females (84.1%). Age, race/ethnicity, tumor size, and overall survival further varied across uncommon pituitary tumor types. CONCLUSIONS Our findings provide a detailed contemporary dissection of the epidemiology of common and uncommon adult pituitary tumors in the context of WHO2017.
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Affiliation(s)
- Luz E Castellanos
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Timothy Smith
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Pituitary and Neuroendocrine Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's, Boston, MA, USA
| | - Edward R Laws
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Pituitary and Neuroendocrine Center, Brigham and Women's Hospital, Boston, MA, USA
| | - J Bryan Iorgulescu
- Harvard Medical School, Boston, MA, USA.
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's, Boston, MA, USA.
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, 75 Francis St., Boston, MA, 02115, USA.
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Dhawan S, Alattar AA, Bartek J, Ma J, Bydon M, Venteicher AS, Chen CC. Racial disparity in recommendation for surgical resection of skull base chondrosarcomas: A Surveillance, Epidemiology, and End Results (SEER) analysis. J Clin Neurosci 2021; 94:186-191. [PMID: 34863436 DOI: 10.1016/j.jocn.2021.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/09/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is increased appreciation of racial disparities in the delivery of neurosurgical care. Here, we explore whether race influences surgical recommendations in the management of skull base chondrosarcomas. METHODS We identified 493 patients with skull base chondrosarcoma using the Surveillance, Epidemiology, and End Results (SEER) registry (November 2017 submission). Regression analyses were performed to identify demographic variables associated with recommendation against surgery. Univariate and multivariate cox proportional hazards models were used for survival analysis. RESULTS In a univariate analysis, we found that the African-American race was associated with an increased likelihood of surgeon recommendation against surgery (OR = 4.416, 95% CI = 1.893-10.302, p = 0.001). This association remained robust in the multivariate model that controlled for other covariates, including age of diagnosis (OR = 5.091, 95% CI = 2.127-12.187, p < 0.001). For patients who received a recommendation against surgery, the likelihood of dying from non-chondrosarcoma causes was comparable between Caucasian and African-American patients, suggesting that the prevalence and severity of medical conditions that increase the risk of death were comparable between these cohorts (HR = 0.466, 95% CI = 0.057-3.802, p = 0.475). The likelihood of dying from chondrosarcoma was comparable between Caucasian and African-American patients who underwent surgery (HR = 0.982, 95% CI = 0.353-2.732, p = 0.973), suggesting absence of race-specific surgical benefits. CONCLUSION We identified a racial disparity against African-Americans in recommendations for surgical resection of skull base chondrosarcomas.
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Affiliation(s)
- Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Ali A Alattar
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jun Ma
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Pennington Z, Ehresman J, Pittman PD, Ahmed AK, Lubelski D, McCarthy EF, Goodwin CR, Sciubba DM. Chondrosarcoma of the spine: a narrative review. Spine J 2021; 21:2078-2096. [PMID: 33971325 DOI: 10.1016/j.spinee.2021.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/19/2021] [Accepted: 04/28/2021] [Indexed: 02/03/2023]
Abstract
Chondrosarcoma is an uncommon primary bone tumor with an estimated incidence of 0.5 per 100,000 patient-years. Primary chondrosarcoma of the mobile spine and sacrum cumulatively account for less than 20% of all cases, most .commonly causing patients to present with focal pain with or without radiculopathy, or myelopathy secondary to neural element compression. Because of the rarity, patients benefit from multidisciplinary care at academic tertiary-care centers. Current standard-of-care consists of en bloc surgical resection with negative margins; for high grade lesions adjuvant focused radiation with ≥60 gray equivalents is taking an increased role in improving local control. Prognosis is dictated by lesion grade at the time of resection. Several groups have put forth survival calculators and epidemiological evidence suggests prognosis is quite good for lesions receiving R0 resection. Future efforts will be focused on identifying potential chemotherapeutic adjuvants and refining radiation treatments as a means of improving local control.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, MN USA 55905; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287.
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ USA 85013.
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC USA 27710
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC USA 27710
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY USA 11030.
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Merna C, Lehrich BM, Kshirsagar RS, Eide JG, Diaz-Aguilar LD, Goshtasbi K, Yasaka TM, Sahyouni R, Palmer JN, Adappa ND, Hsu FPK, Kuan EC. Determinants of Survival in Skull Base Chondrosarcoma: A National Cancer Database Study. World Neurosurg 2021; 158:e766-e777. [PMID: 34808412 DOI: 10.1016/j.wneu.2021.11.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Chondrosarcomas of the skull base are rare tumors most commonly treated surgically with or without adjuvant radiation therapy. Using the National Cancer Database (NCDB), we analyzed overall survival (OS), treatment modalities, and prognosticators. METHODS The NCDB was queried for all cases of histologically confirmed skull base chondrosarcoma treated between 2004 and 2015, excluding patients with more than 1 malignant tumor, on palliative care, receiving unrelated concurrent treatments, or having less than 1 month of follow-up. The χ2 test for categorical variables, Cox proportional hazards models, and Kaplan-Meier log-rank analysis were used to test associations with the use of adjuvant radiation, OS, and survival time. RESULTS A total of 498 patients with skull base chondrosarcoma were identified in the NCDB. Of them, 224 (45.0%) and 198 (39.8%) were treated with either surgery alone or surgery with adjuvant radiation therapy, respectively. Patients more likely to undergo surgery with adjuvant radiation had higher tumor grade (P = 0.008), later year of diagnosis (P = 0.002), positive surgical margins (P < 0.001), and treatment at an academic institution (P = 0.02). Patient, tumor, and socioeconomic factors associated with worse OS on multivariate analysis included the Charlson/Deyo Comorbidity Score ≥2 (P = 0.017), as well as clear cell (P = 0.02) and dedifferentiated (P = 0.006) histology. Age, tumor grade, tumor size, treatment modality, insurance status, facility type, and urban/rural population did not show a statistically significant impact on OS. CONCLUSION The mainstay of treatment for skull base chondrosarcoma is surgery, with consideration of adjuvant radiation. This study demonstrated worse overall survival associated with more frail patients and aggressive histology types. It is important to consider these factors when planning the clinical management of these patients.
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Affiliation(s)
- Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Brandon M Lehrich
- School of Medicine, University of California, Irvine, Orange, California, USA
| | - Rijul S Kshirsagar
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacob G Eide
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Khodayar Goshtasbi
- School of Medicine, University of California, Irvine, Orange, California, USA
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - James N Palmer
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.
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Abdallah HM, Gersey ZC, Muthiah N, McDowell MM, Pearce T, Costacou T, Snyderman CH, Wang EW, Gardner PA, Zenonos GA. An Integrated Management Paradigm for Skull Base Chordoma Based on Clinical and Molecular Characteristics. J Neurol Surg B Skull Base 2021; 82:601-607. [PMID: 34745826 DOI: 10.1055/s-0041-1730958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022] Open
Abstract
Objective Previous work categorized skull base chordoma (SBC) into three genetic risk groups based on 1p36 and homozygous 9p21(p16) deletions, accounting for a wide variability in prognosis (A = low-risk, B = intermediate-risk, C = high-risk). However, it remains unclear how these groups could guide management. Study Design By integrating surgical outcome and adjuvant radiation (AdjXRT) information with genetic data on 152 tumors, we sought to develop an evidence-based management algorithm for SBC. Results Gross total resections (GTRs) were associated with improved progression free survival (PFS) in all genetic groups. For Group C tumors, GTR and AdjXRT independently contributed to PFS (multivariate Cox proportional hazard ratio [HR] = 0.14, p = 0.002, and HR = 0.40, p = 0.047, respectively). For Group B tumors, AdjXRT improved outcomes only when GTR was not feasible (log-rank p = 0.008), but not following GTR (log-rank p = 0.54). However, 24 of 25 Group A tumors underwent GTR, and AdjXRT for these did not confer any benefit (log-Rank p = 0.285). The high GTR rates in Group A could be explained by smaller tumor sizes (mean = 0.98cc/4.08cc/4.92cc for Group A/B/C, respectively, p = 0.031) and lack of invasiveness. Group A tumors were also more frequently diagnosed in young people ( p = 0.002) as asymptomatic lesions ( p = 0.001), suggesting that they could be precursors to tumors in higher risk groups. Conclusion Genotypic grouping by 1p36 and homozygous 9p21(p16) deletions can predict prognosis in SBC and guide management. GTR remains the cornerstone of SBC treatment and can be sufficient without AdjXRT in low and intermediate risk tumors. Low-risk tumors are associated with a less invasive phenotype, which makes them more amenable to GTR.
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Affiliation(s)
- Hussein M Abdallah
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Nallammai Muthiah
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Thomas Pearce
- Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Division of Neuropathology, Pittsburgh, Pennsylvania, United States
| | - Tina Costacou
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Rimmer RA, Mace JC, Andersen PE, Cetas JS, Ciporen JN, Dogan A, Smith TL, Geltzeiler M. Determinants of survival in sinonasal and skull base chondrosarcoma: An analysis of the National Cancer Database. Int Forum Allergy Rhinol 2021; 12:699-713. [PMID: 34704402 DOI: 10.1002/alr.22909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chondrosarcomas are rare, malignant chondroid tumors that can occur in the sinonasal and skull base regions. Surgery is a mainstay of treatment, but complete resection can be challenging because of the close proximity of critical neurovascular structures. Because of their rarity and relatively indolent nature, optimal treatment regimens are not established. Our objective was to assess determinants of survival for sinonasal and skull base chondrosarcomas utilizing the National Cancer Database (NCDB). METHODS The NCDB (2004-2017) was queried for cases of sinonasal and skull base chondrosarcoma. Multivariate hazard regression modeling was used to identify significant predictors of 60-month and 120-month overall survival (OS). RESULTS Seven hundred thirty-six cases met inclusion criteria. OS for all treatment types was 84.7% [SE±0.02] at 60 months and 75.6% [SE±0.02] at 120 months. Surgery with or without adjuvant treatment was found to associate with highest OS at 60 and 120 months. For patients receiving adjuvant radiation during treatment, proton therapy had significantly better OS at 60 months (95.4% [SE±0.03] vs 82.3% [SE±0.03], -2 = 5.27; p = 0.02) and 120 months (85.1% [SE±0.08] vs 72.8% [SE±0.05], -2 = 4.11; p = 0.04) compared with conventional external beam. After adjustment for primary site, multivariate Cox regression modeling (n = 561) identified cofactors significantly associated with variation in mortality risk at 60 and 120 months, including age, Charlson-Deyo total score ≥ 3, insurance provision status, and tumor grade. CONCLUSIONS Sinonasal and skull base chondrosarcoma are primarily treated with surgery with favorable OS. Adjuvant treatment may be required and proton radiation was associated with improved 60-month and 120-month survival compared with conventional radiation.
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Affiliation(s)
- Ryan A Rimmer
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Jess C Mace
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Peter E Andersen
- Division of Head & Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Justin S Cetas
- Division of Skull Base and Cerebrovascular, Department of Neurological Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Jeremy N Ciporen
- Department of Neurological Surgery, Oregon Health & Science University-Tuality Healthcare, Hillsboro, OR
| | - Aclan Dogan
- Division of Skull Base and Cerebrovascular, Department of Neurological Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Timothy L Smith
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Mathew Geltzeiler
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, OR
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Sallabanda M, Garcia R, Lorenzana L, Santaolalla I, Abarca J, Sallabanda K. Treatment of Chordomas and Chondrosarcomas With CyberKnife Robotic Hypofractionated Radiosurgery: A Single Institution Experience. Cureus 2021; 13:e17012. [PMID: 34405079 PMCID: PMC8352833 DOI: 10.7759/cureus.17012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The aim of this study is to determine the efficacy and safety of CyberKnife® (Accuray, Inc., Sunnyvale, CA) hypofractionated radiosurgery (HfRS) in the treatment of chordomas and chondrosarcomas. Methods A total of 24 patients retrospectively identified with chordomas (19 patients) or chondrosarcomas (five patients) were treated between 2012 and 2019 with HfRS as monotherapy or an adjuvant, rescue, or combination therapy. Tumors were located in the skull base (75%) and vertebral spine (25%). Of these, 19 patients underwent previous partial resection and four patients received previous conventional external beam radiation therapy (EBRT) (60-74 Gy). Exclusive or rescue HfRS (20 patients) was administered in five fractions with a median dose of 37.5 Gy (30-40 Gy). Combined tomotherapy-EBRT treatment (median dose: 54 Gy) and HfRS (16.5-30 Gy in 3-12 fractions) were performed in four patients with bulky chordomas. Results The median follow-up from HfRS was 28 months. During clinical follow-up, no deaths were registered with overall survival (OS) of 100% and the actuarial local recurrence-free survival (LRFS) was 93% at one year, 85% at three years, and 68% at five years. Acute toxicity related to HfRS was present in a single patient. Conclusions It is seen that HfRS is effective and safe for chordomas and chondrosarcomas, with rates of LRFS comparable to other radiation modalities.
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Affiliation(s)
| | - Rafael Garcia
- Radiation Oncology, Genesis Care Cyberknife Center, Madrid, ESP
| | - Luis Lorenzana
- Neurosurgery, Genesis Care Cyberknife Center, Madrid, ESP
| | | | - Javier Abarca
- Neurological Surgery, Hospital General de Alicante, Madrid, ESP
| | - Kita Sallabanda
- Radiosurgery/Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, ESP
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Hug EB, Pelak M, Frank SJ, Fossati P. A Review of Particle Therapy for Skull Base Tumors: Modern Considerations and Future Directions. Int J Part Ther 2021; 8:168-178. [PMID: 34285944 PMCID: PMC8270106 DOI: 10.14338/ijpt-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Eugen B Hug
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Maciej Pelak
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Steven J Frank
- MD Anderson Cancer Center, Division of Radiation Oncology, Houston, TX, USA
| | - Piero Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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Traylor JI, Pernik MN, Plitt AR, Lim M, Garzon-Muvdi T. Immunotherapy for Chordoma and Chondrosarcoma: Current Evidence. Cancers (Basel) 2021; 13:2408. [PMID: 34067530 PMCID: PMC8156915 DOI: 10.3390/cancers13102408] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/21/2022] Open
Abstract
Chordomas and chondrosarcomas are rare but devastating neoplasms that are characterized by chemoradiation resistance. For both tumors, surgical resection is the cornerstone of management. Immunotherapy agents are increasingly improving outcomes in multiple cancer subtypes and are being explored in chordoma and chondrosarcoma alike. In chordoma, brachyury has been identified as a prominent biomarker and potential molecular immunotherapy target as well as PD-1 inhibition. While studies on immunotherapy in chondrosarcoma are sparse, there is emerging evidence and ongoing clinical trials for PD-1 as well as IDH inhibitors. This review highlights potential biomarkers and targets for immunotherapy in chordoma and chondrosarcoma, as well as current clinical evidence and ongoing trials.
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Affiliation(s)
- Jeffrey I. Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
| | - Mark N. Pernik
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
| | - Aaron R. Plitt
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
| | - Michael Lim
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94305, USA;
| | - Tomas Garzon-Muvdi
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA; (J.I.T.); (M.N.P.); (A.R.P.)
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Prognostic Factors and a Nomogram Predicting Overall Survival in Patients with Limb Chondrosarcomas: A Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4510423. [PMID: 34055971 PMCID: PMC8147544 DOI: 10.1155/2021/4510423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/03/2021] [Indexed: 02/02/2023]
Abstract
Introduction We aimed to develop and validate a nomogram for predicting the overall survival of patients with limb chondrosarcomas. Methods The Surveillance, Epidemiology, and End Results (SEER) program database was used to identify patients diagnosed with chondrosarcomas, from which data was extracted from 18 registries in the United States between 1973 and 2016. A total of 813 patients were selected from the database. Univariate and multivariate analyses were performed using Cox proportional hazards regression models on the training group to identify independent prognostic factors and construct a nomogram to predict the 3- and 5-year survival probability of patients with limb chondrosarcomas. The predictive values were compared using concordance indexes (C-indexes) and calibration plots. Results All 813 patients were randomly divided into a training group (n = 572) and a validation group (n = 241). After univariate and multivariate Cox regression, a nomogram was constructed based on a new model containing the predictive variables of age, site, grade, tumor size, histology, stage, and use of surgery, radiotherapy, or chemotherapy. The prediction model provided excellent C-indexes (0.86 and 0.77 in the training and validation groups, respectively). The good discrimination and calibration of the nomograms were demonstrated for both the training and validation groups. Conclusions The nomograms precisely and individually predict the overall survival of patients with limb chondrosarcomas and could assist personalized prognostic evaluation and individualized clinical decision-making.
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Metcalfe C, Muzaffar J, Kulendra K, Sanghera P, Shaw S, Shad A, Saravanappa N, Paluzzi A, Ahmed S. Chordomas and chondrosarcomas of the skull base: treatment and outcome analysis in a consecutive case series of 24 patients. World J Surg Oncol 2021; 19:68. [PMID: 33750413 PMCID: PMC7945343 DOI: 10.1186/s12957-021-02178-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background We present our 9-year consecutive case series of skull base chordomas and chondrosarcomas from a UK tertiary referral centre, discussing treatments offered and outcomes. This was carried out to improve understanding around current treatment and to better inform the management of future patients. Methods Consecutive case series over a 9-year period (2007–2016). Retrospective data analysis from the electronic skull base multidisciplinary team database and the digital patient records at a UK tertiary referral centre Results Twenty-four patients were identified (11 chordomas, 13 chondrosarcomas, mean age 52). Nineteen had proton beam therapy (PBT) postoperatively; two had intensity-modulated radiotherapy; two had no further treatment. One patient was lost to follow-up. All chordomas were resected via a transnasal endoscopic approach. Of the 19 patients undergoing resection with PBT, 13 were disease free at latest follow-up, and six patients had local recurrence, of which two died (mean follow up 7.4 years). Of the three patients treated with surgery then IMRT/TomoTherapy, one died 4 years post-treatment, and the other two are alive after 4 and 5 years of follow-up respectively. Of the two patients treated with surgery alone, one was lost to follow-up, and the other is alive after more than 8 years. Chondrosarcoma 5-year survival was 91.6%, and chordoma 4-year survival was 75%. Conclusion Skull base chordomas and chondrosarcomas can be challenging to resect, and most cases require adjuvant therapy to achieve control. Where complete resection is not possible, it is critical to undertake sufficient resection to permit high-dose radiation.
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Affiliation(s)
- Christopher Metcalfe
- Regional Skull-Base Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Jameel Muzaffar
- Regional Skull-Base Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Kevin Kulendra
- Regional Skull-Base Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Paul Sanghera
- Regional Skull-Base Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Simon Shaw
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK
| | - Amjad Shad
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | | | - Alessandro Paluzzi
- Regional Skull-Base Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Shahzada Ahmed
- Regional Skull-Base Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, UK.
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Barber SM, Sadrameli SS, Lee JJ, Fridley JS, Teh BS, Oyelese AA, Telfeian AE, Gokaslan ZL. Chordoma-Current Understanding and Modern Treatment Paradigms. J Clin Med 2021; 10:jcm10051054. [PMID: 33806339 PMCID: PMC7961966 DOI: 10.3390/jcm10051054] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022] Open
Abstract
Chordoma is a low-grade notochordal tumor of the skull base, mobile spine and sacrum which behaves malignantly and confers a poor prognosis despite indolent growth patterns. These tumors often present late in the disease course, tend to encapsulate adjacent neurovascular anatomy, seed resection cavities, recur locally and respond poorly to radiotherapy and conventional chemotherapy, all of which make chordomas challenging to treat. Extent of surgical resection and adequacy of surgical margins are the most important prognostic factors and thus patients with chordoma should be cared for by a highly experienced, multi-disciplinary surgical team in a quaternary center. Ongoing research into the molecular pathophysiology of chordoma has led to the discovery of several pathways that may serve as potential targets for molecular therapy, including a multitude of receptor tyrosine kinases (e.g., platelet-derived growth factor receptor [PDGFR], epidermal growth factor receptor [EGFR]), downstream cascades (e.g., phosphoinositide 3-kinase [PI3K]/protein kinase B [Akt]/mechanistic target of rapamycin [mTOR]), brachyury—a transcription factor expressed ubiquitously in chordoma but not in other tissues—and the fibroblast growth factor [FGF]/mitogen-activated protein kinase kinase [MEK]/extracellular signal-regulated kinase [ERK] pathway. In this review article, the pathophysiology, diagnosis and modern treatment paradigms of chordoma will be discussed with an emphasis on the ongoing research and advances in the field that may lead to improved outcomes for patients with this challenging disease.
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Affiliation(s)
- Sean M. Barber
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Saeed S. Sadrameli
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Jonathan J. Lee
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Jared S. Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Adetokunbo A. Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
- Correspondence: ; Tel.: +1-(401)-793-9132
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Pennington Z, Ehresman J, McCarthy EF, Ahmed AK, Pittman PD, Lubelski D, Goodwin CR, Sciubba DM. Chordoma of the sacrum and mobile spine: a narrative review. Spine J 2021; 21:500-517. [PMID: 33589095 DOI: 10.1016/j.spinee.2020.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
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Zhou L, Huang R, Wei Z, Meng T, Yin H. The Clinical Characteristics and Prediction Nomograms for Primary Spine Malignancies. Front Oncol 2021; 11:608323. [PMID: 33732642 PMCID: PMC7959809 DOI: 10.3389/fonc.2021.608323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background Primary spine malignancies (PSMs) are relatively rare in bone tumors. Due to their rarity, the clinical characteristics and prognostic factors are still ambiguous. In this study, we aim to identify the clinical features and proposed prediction nomograms for patients with PSMs. Methods Patients diagnosed with PSMs including chordoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, and malignant giant cell tumor of bone (GCTB) between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The patient and tumor characteristics were described based on clinical information. The significant prognostic factors of overall survival (OS) and cancer-specific survival (CSS) were identified by the univariate and multivariate Cox analysis. Then, the nomograms for OS and CSS were established based on the selected predictors and their accuracy was explored by the Cox–Snell residual plot, area under the curve (AUC) of receiver operator characteristic (ROC) and calibration curve. Results The clinical information of 1,096 patients with PSMs was selected from the SEER database between 1975 and 2016. A total of 395 patients were identified with full survival and treatment data between 2004 and 2016. Chordoma is the commonest tumor with 400 cases, along 172 cases with osteosarcoma, 240 cases with chondrosarcoma, 262 cases with Ewing sarcoma and 22 cases with malignant GCTB. The univariate and multivariate analyses revealed that older age (Age > 60), distant metastasis, chemotherapy, and Surgery were independent predictors for OS and/or CSS. Based on these results, the nomograms were established with a better applicability (AUC for CSS: 0.784; AUC for OS: 0.780). Conclusions This study provides the statistics evidence for the clinical characteristics and predictors for patients with PSMs based on a large size population. Additionally, precise prediction nomograms were also established with a well-applicability.
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Affiliation(s)
- Lei Zhou
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Bone Tumor Institution, Shanghai, China
| | - Runzhi Huang
- Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Ziheng Wei
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Bone Tumor Institution, Shanghai, China
| | - Tong Meng
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Bone Tumor Institution, Shanghai, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Bone Tumor Institution, Shanghai, China
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Xu G, Wu H, Xu Y, Zhang Y, Lin F, Baklaushev VP, Chekhonin VP, Peltzer K, Wang X, Mao M, Wang G, Cui P, Zhang C. Homogenous and Heterogenous Prognostic Factors for Patients with Bone Sarcoma. Orthop Surg 2020; 13:134-144. [PMID: 33305494 PMCID: PMC7862145 DOI: 10.1111/os.12851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to examine the survival rate of patients with different bone sarcomas and to investigate homogenous and heterogenous prognostic factors for different types of bone sarcomas. Methods This is a retrospective analysis of records from the Surveillance, Epidemiology, and End Result (SEER) database. Clear information on the distant metastasis of cancer is provided in the SEER database for patients diagnosed between January 2010 and December 2016. Data for the four types of malignant bone sarcomas were extracted, including osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma. Patients with bone sarcomas originated from other sites, diagnosed at autopsy, or indicated in death certification were excluded. The overall survival was calculated for the entire cohort and across different bone sarcomas using the Kaplan–Meier method. A subgroup analysis of the different survival rates of four types of bone sarcomas in various levels of each variable was conducted and the differences were tested with the log‐rank test. Cox proportional hazard regression analysis was performed to determine the prognostic factors. Variables with P < 0.05 in the univariate Cox regression analysis were further analyzed using a multivariate Cox regression analysis. The prognostic factors in four groups of bone sarcomas were compared to determine the homogenous and heterogenous factors. Results A total of 4732 patients were included with a follow up of 25 (0–83) months. The mean age of patients was 39.7 ± 24.1 years. The 1‐year, 3‐year, and 5‐year overall survival rate for the entire cohort was 86.2% (95% confidence interval [CI]: 85.2%–87.2%), 70.5% (95% CI: 68.9%–72.1%), and 63.0% (95% CI: 61.2%–64.8%), respectively. Factors including age older than 40 years, higher grade, regional and distant stage, tumor in the extremities, T2 stage, bone and lung metastases, and non‐surgery were significantly associated with the poor survival of the entire cohort. The mean overall survival duration of patients with chordoma, chondrosarcoma, Ewing sarcoma, and osteosarcoma was 66.86 (95% CI: 64.06–69.66), 63.53 (95% CI: 61.81–65.25), 58.06 (95% CI: 55.49–60.62) and 54.91 (95% CI: 53.14–56.69) months, respectively. Compared with chordoma, the hazard ratio (HR) and 95% CI for patients with chondrosarcoma, Ewing sarcoma, and osteosarcoma were 1.30 (95% CI: 1.04–1.62; P = 0.023), 1.69 (95% CI: 1.33–2.14; P < 0.001), and 2.00 (95% CI: 1.61–2.48; P <0.001), respectively. Different bone sarcomas showed homogenous and heterogenous prognostic factors. Conclusion Different clinicopathological characteristics and prognoses were revealed in patients with osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma. The risk factors can potentially guide prognostic prediction and sarcoma‐specific treatment.
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Affiliation(s)
- Guijun Xu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China.,Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Haixiao Wu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yao Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yanting Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Feng Lin
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Vladimir P Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow, Russian Federation
| | - Vladimir P Chekhonin
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Min Mao
- Department of Pathology, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Cui
- Department of Public Health, Jining Medical University, Jining, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Abstract
Chordomas are rare tumors which arise from the embryological remnants of the notochord. These tumors can potentially arise from any region within the craniospinal axis and often clinically present as a diagnostic challenge. Chordomas are rare in patients younger than 40 years of age. The most common primary cancers that metastasize to the jaw bones are the ones originating from the breast, lung, kidney adrenal, colo-rectum, or prostate. Mandibular metastasis from a primary chordoma is an extremely rare occurrence with only five prior reports, three originating from primaries in the sacrococcygeal region, one from a lumbar spine primary and the other from a primary arising from the spheno-occipital region. A literature review did not reveal any prior reports of mandibular metastasis at presentation from a clival chordoma. We possibly report the first case of such an unusual clinical scenario in a 7-year-old male child and further discuss the evaluation and management of these rare tumors.
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Affiliation(s)
- Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Holley C, Breining T, Scheithauer M, Möller P, Barth TFE. [Primary extra-axial chondroid chordoma of the anterior nasal septum: case report of a rare chordoma with literature review]. HNO 2020; 69:221-228. [PMID: 33095325 DOI: 10.1007/s00106-020-00957-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
An 87-year-old patient reported a nodular, progressively enlarging mass of the anterior nasal septum leading to partial obstruction of the nostrils. The tumor showed no infiltration of the subcutis, bone, or paranasal sinuses in imaging or intraoperatively. Histological examination revealed a chondroid tumor with lobular growth and physaliferous cell morphology. Immunohistochemistry revealed a brachyury-positive tumor without EWSR1 rearrangement, leading to the diagnosis of a chondroid chordoma. The reported case demonstrates the differential diagnostic considerations pertaining to this rare tumor, which can also have an untypical and very rare extra-axial location. Review of the literature identified 34 primary extraosseous chordomas of the nose, nasopharynx, and paranasal sinuses, and allowed the nasal chordoma presented herein to be included in this group of extra-axial chordomas.
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Affiliation(s)
- C Holley
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - T Breining
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - M Scheithauer
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T F E Barth
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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Dibas M, Doheim MF, Ghozy S, Ros MH, El-Helw GO, Reda A. Incidence and survival rates and trends of skull Base chondrosarcoma: A Population-Based study. Clin Neurol Neurosurg 2020; 198:106153. [PMID: 32818757 DOI: 10.1016/j.clineuro.2020.106153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/16/2020] [Accepted: 08/09/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Chondrosarcomas are extremely rare, locally invasive, and potentially mortal malignant cartilaginous tumors. In this study, we aimed to evaluate the incidence and survival rates and trends of skull base chondrosarcomas (SBC). METHODS Data from SBC patients between 1975 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The age-adjusted incidence rates (AAR) were calculated for the overall cases and based on gender, age, race, and histology. Furthermore, the relative survival rates for one, three, and five years, and the rates stratified to the aforementioned selected variables were computed. Besides, we conducted a joint point regression analysis to calculate the annual percent change (APC) and its associated standard error (SE) for AAR and mortality. RESULTS The AAR rate of SBC was 0.019 per 100,000. Higher AAR rates were observed in patients who were in the 65-74-year-age-group, females, Caucasians, and had none mesenchymal subtype. The relative one-year, three-year and five-year-survival rates were 99.58 %, 93.67 %, and 89.10 %, respectively. Lower survival rates were noted in patients who were males, African Americans, and had a mesenchymal subtype. The trend analysis has shown a significant yearly increase (P < 0.001) in AAR of SBC (APC ± SE = 0.0005 %±0.0001), along with a significant yearly decline in mortality rates (APC ± SE= -0.0202 %±0.0029). CONCLUSION Despite the increase in AAR over time, there has been a significant decline in mortality rates over time, which might have been due to the advancement of treatment modalities, improvement in diagnostic imaging, and modification in disease grading.
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Affiliation(s)
- Mahmoud Dibas
- College of Medicine, Sulaiman Al Rajhi University, Qassim, Saudi Arabia; Global Medical Research Initiative (GMRI).
| | - Mohamed Fahmy Doheim
- Faculty of Medicine, Alexandria University, Alexandria, Egypt; Global Medical Research Initiative (GMRI).
| | - Sherief Ghozy
- Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt; Faculty of Medicine, Mansoura University, Mansoura, Egypt; Global Medical Research Initiative (GMRI).
| | - Mohamed Hassan Ros
- Faculty of Medicine, Mansoura University, Mansoura, Egypt; Global Medical Research Initiative (GMRI).
| | - Ghidaa Osama El-Helw
- Faculty of Medicine, Beni Suef University, Egypt; Global Medical Research Initiative (GMRI).
| | - Abdullah Reda
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Global Medical Research Initiative (GMRI).
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
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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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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Hottinger AL, Bojaxhiu B, Ahlhelm F, Walser M, Bachtiary B, Zepter S, Lomax T, Pica A, Weber DC. Prognostic impact of the "Sekhar grading system for cranial Chordomas" in patients treated with pencil beam scanning proton therapy: an institutional analysis. Radiat Oncol 2020; 15:96. [PMID: 32375820 PMCID: PMC7201750 DOI: 10.1186/s13014-020-01547-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Skull base chordomas are rare and heterogeneously behaving tumors. Though still classified as benign they can grow rapidly, are locally aggressive, and have the potential to metastasize. To adapt the treatment to the specific needs of patients at higher risk of recurrence, a pre-proton therapy prognostic grading system would be useful. The aim of this retrospective analysis is to assess prognostic factors and the "Sekhar Grading System for Cranial Chordomas" (SGSCC) by evaluating the larger cohort of patients treated at our institution as to determine its reproducibility and ultimately to ensure more risk adapted local treatments for these challenging tumors. METHODS We analyzed 142 patients treated for skull base chordomas between 2004 and 2016. We focused the analysis on the 5 criteria proposed for the SGSCC (tumor size, number of anatomic regions and vessels involved, intradural invasion, as well as recurrence after prior treatment) and classified our patients according to their score (based on the above mentioned criteria) into three prognostic groups, low-risk, intermediate-risk and high-risk. The three groups were then analyzed in regards of local control, local recurrence-free survival and overall survival. RESULTS The median follow up was 52 months (range, 3-152). We observed 34 (24%) patients with a local recurrence, resulting in a local control of 75% at 5 years. Overall survival was 83% at 5 years, 12 (9%) patients had died due to local progression. When split into the three prognostic groups according to the SGSCC the observed local control was 90, 72 and 64% (p = 0.07) in the low-, intermediate- and high-risk group, respectively. A similar correlation was observed for local recurrence-free survival with 93, 89 and 66% (p = 0.05) and for overall survival with 89, 83 and 76% (p = 0.65) for the same prognostic groups. CONCLUSIONS After splitting our patient cohort into the three SGSCC risk groups, we found a trend towards better outcome for those patients with lower as opposed to higher scores. These results suggest that this prognostic grading system published by Sekhar et al. could be integrated in the management decision-tree for patients with skull base chordoma.
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Affiliation(s)
- Anna-Lena Hottinger
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland
| | - Beat Bojaxhiu
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland
| | - Frank Ahlhelm
- Neuroradiology Department, Kantonsspital Baden, Baden, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland
| | - Stefan Zepter
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland
| | - Tony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland
- Department of Physics, ETH Zürich, Zürich, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 PSI West, Villigen, Switzerland.
- Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland.
- Radiation Oncology Department, University Hospital of Zürich, Zürich, Switzerland.
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Uneda A, Kurozumi K, Fujimura A, Kamiya A, Hirose T, Yanai H, Date I. Intracranial Mesenchymal Chondrosarcoma Lacking the Typical Histopathological Features Diagnosed by HEY1-NCOA2 Gene Fusion. NMC Case Rep J 2020; 7:47-52. [PMID: 32322450 PMCID: PMC7162808 DOI: 10.2176/nmccrj.cr.2019-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/13/2019] [Indexed: 11/20/2022] Open
Abstract
Intracranial mesenchymal chondrosarcoma (MCS) is a rare neoplasm. The diagnosis of MCS is confirmed by the presence of a biphasic pattern on histological examination, comprising undifferentiated small round cells admixed with islands of well-differentiated hyaline cartilage; however, a differential diagnosis may be challenging in some cases. A 28-year-old woman with a 2-month history of headache was referred to our hospital. Radiologic studies showed an extra-axial lobulated mass composed of calcified and uncalcified areas occupying the left middle fossa. Surgical resection was planned, but her headache suddenly worsened before her planned hospital admission and she was admitted as an emergency. Radiologic studies showed an acute hemorrhage in the uncalcified part of the mass. The mass was resected via the left zygomatic approach after embolization of the feeder vessels. The most likely histopathological diagnosis was MCS. However, the typical bimorphic pattern was not identified in our surgical samples; each undifferentiated area and well-differentiated area was observed separately in different tissue specimens, and no islands of well-differentiated hyaline cartilage were identified within the undifferentiated areas in the same specimen. Molecular assays confirmed the presence of HEY1-NCOA2 fusion. IRF2BP2-CDX1 fusion and IDH1/2 mutations were negative. The final diagnosis of MCS was made based on the presence of HEY1-NCOA2 gene fusion. MCS should be included in the differential diagnosis when radiologic studies show an extra-axial lobulated mass with calcification. Furthermore, molecular demonstration of HEY1-NCOA2 gene fusion may help make a precise diagnosis of MCS, especially in surgical samples lacking the typical histopathological features.
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Affiliation(s)
- Atsuhito Uneda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan.,Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Kazuhiko Kurozumi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Atsushi Fujimura
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Atsunori Kamiya
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Takanori Hirose
- Department of Diagnostic Pathology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
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Noor A, Bindal P, Ramirez M, Vredenburgh J. Chordoma: A Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e918927. [PMID: 31969553 PMCID: PMC6998794 DOI: 10.12659/ajcr.918927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Female, 68-year-old Final Diagnosis: Chordoma Symptoms: Hoarseness • neck pain • weakness Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Arish Noor
- Internal Medicine, University of Connecticut, Farmington, CT, USA
| | - Poorva Bindal
- Internal Medicine, University of Connecticut, Farmington, CT, USA
| | - Miguel Ramirez
- Department of Radiology, St. Francis Hospital, Hartford, CT, USA
| | - James Vredenburgh
- Department of Hematology Oncology, St. Francis Hospital, Hartford, CT, USA
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Abstract
Clinically, radiologically, and pathologically, chondroid neoplasms of the skull can be diagnostically challenging due to overlapping features in each of these domains. Compounding the problem for the pathologist, there is also significant morphologic, immunophenotypic, and molecular genetic overlap between benign and malignant cartilaginous lesions, and the majority of these lesions are encountered quite rarely in routine surgical pathology practice. Each of these factors contribute to the diagnostic difficulty posed by these lesions, highlighting the importance of radiologic-pathologic correlation in the diagnosis. This review is intended to provide an update for surgical pathologists on some of the most commonly encountered chondroid neoplasms in the skull, and includes the following lesions: chondromyxoid fibroma, synovial chondromatosis, chondrosarcoma and variants, and chordoma and variants. For each of these lesions, the differential diagnosis and useful ancillary tests will be discussed in the context of a broad range of additional primary and secondary lesions.
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