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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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2
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Yoo HD, Chung JC, Park KS, Chung SY, Park MS, Ryu S, Kim SM. Long-Term Outcomes after Multimodal Treatment for Clival Chordoma: Efficacy of the Endonasal Transclival Approach with Early Adjuvant Radiation Therapy. J Clin Med 2023; 12:4460. [PMID: 37445495 DOI: 10.3390/jcm12134460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
This study investigates the long-term outcomes of clival chordoma patients treated with the endonasal transclival approach (ETCA) and early adjuvant radiation therapy. A retrospective review of 17 patients (2002-2013) showed a 10-year progression-free survival (PFS) rate of 67.4%, with the ETCA group showing fewer progressions and cranial neuropathies than those treated with combined approaches. The ETCA, a minimally invasive technique, provided a similar extent of resection compared to conventional skull-base approaches and enabled safe delivery of high-dose adjuvant radiotherapy. The findings suggest that ETCA is an effective treatment for centrally located clival chordomas.
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Affiliation(s)
- Hyun Dong Yoo
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon 35233, Republic of Korea
| | - Jong Chul Chung
- Center for Neuromodulation, Department of Neurosurgery, NYU Langone Medical Center, New York, NY 11021, USA
| | - Ki Seok Park
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon 35233, Republic of Korea
| | - Seung Young Chung
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon 35233, Republic of Korea
| | - Moon Sun Park
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon 35233, Republic of Korea
| | - Seungjun Ryu
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon 35233, Republic of Korea
| | - Seong Min Kim
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon 35233, Republic of Korea
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3
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Teng C, Yang Q, Xiong Z, Ye N, Li X. Multivariate Analysis and Validation of the Prognostic Factors for Skull Base Chordoma. Front Surg 2021; 8:764329. [PMID: 34888345 PMCID: PMC8649658 DOI: 10.3389/fsurg.2021.764329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Skull base chordoma is a rare tumor with low-grade malignancy and a high recurrence rate, the factors affecting the prognosis of patients need to be further studied. For that, we investigated prognostic factors of skull base chordoma through the database of the Surveillance, Epidemiology, and End Results (SEER) program, and validated in an independent data set from the Xiangya Hospital. Methods: Six hundred and forty-three patients diagnosed with skull base chordoma were obtained from the SEER database (606 patients) and the Xiangya Hospital (37 patients). Categorical variables were selected by Chi-square test with a statistical difference. Survival curves were constructed by Kaplan–Meier analysis and compared by log-rank test. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors. Propensity score matching (PSM) analysis was undertaken to reduce the substantial bias between gross total resection (GTR) and subtotal resection (STR) groups. Furthermore, clinical data of 37 patients from the Xiangya Hospital were used as validation cohorts to check the survival impacts of the extent of resection and adjuvant radiotherapy on prognosis. Results: We found that age at diagnosis, primary site, disease stage, surgical treatment, and tumor size was significantly associated with the prognosis of skull base chordoma. PSM analysis revealed that there was no significant difference in the OS between GTR and STR (p = 0.157). Independent data set from the Xiangya Hospital proved no statistical difference in OS between GTR and STR groups (p = 0.16), but the GTR group was superior to the STR group for progression-free survival (PFS) (p = 0.048). Postoperative radiotherapy does not improve OS (p = 0.28), but it can prolong PFS (p = 0.0037). Nomograms predicting 5- and 10-year OS and DSS were constructed based on statistically significant factors identified by multivariate Cox analysis. Age, primary site, tumor size, surgical treatment, and disease stage were included as prognostic predictors in the nomograms with good performance. Conclusions: We identified age, tumor size, surgery, primary site, and tumor stage as main factors affecting the prognosis of the skull base chordoma. Resection of the tumor as much as possible while ensuring safety, combined with postoperative radiotherapy may be the optimum treatment for skull base chordoma.
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Affiliation(s)
- Chubei Teng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China.,Department of Neurosurgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Qi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Zujian Xiong
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Ningrong Ye
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
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4
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Primary Skull Base Chondrosarcomas: A Systematic Review. Cancers (Basel) 2021; 13:cancers13235960. [PMID: 34885071 PMCID: PMC8656924 DOI: 10.3390/cancers13235960] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Primary skull base chondrosarcomas (SBCs) may carry significant tumor-burden by causing severe cranial nerve neuropathies. Current treatment strategies mainly focus on surgical resection and radiotherapy protocols, with a wide range of findings in terms of efficacy and safety. The aim of our systematic review was to comprehensively analyze the current literature on primary SBCs, describing clinical and radiological characteristics, available management strategies, treatment outcomes, and prognoses. We found that most primary SBCs show benign slow-growing patterns but may cause neurological deficits by compressing critical neurovascular structures. Open surgical approaches favor maximal resection with acceptable complication rates, but only a few studies reported the use of newer endoscopic approaches. Proton-based, photon-based, and carbon-based radiotherapy protocols may also allow safe and effective local tumor control as adjuvant treatments or stand-alone strategies in patients not eligible to undergo surgery. Overall, primary SBCs’ prognoses proved to be favorable and comparable to benign skull base neoplasms. Abstract Background: Primary skull base chondrosarcomas (SBCs) can severely affect patients’ quality of life. Surgical-resection and radiotherapy are feasible but may cause debilitating complications. We systematically reviewed the literature on primary SBCs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients with primary SBCs. Clinical characteristics, management strategies, and treatment outcomes were analyzed. Results: We included 33 studies comprising 1307 patients. Primary SBCs mostly involved the middle-fossa (72.7%), infiltrating the cavernous-sinus in 42.4% of patients. Cranial-neuropathies were reported in 810 patients (62%). Surgical-resection (93.3%) was preferred over biopsy (6.6%). The most frequent open surgical approaches were frontotemporal-orbitozygomatic (17.6%) and pterional (11.9%), and 111 patients (21.3%) underwent endoscopic-endonasal resection. Post-surgical cerebrospinal-fluid leaks occurred in 36 patients (6.5%). Radiotherapy was delivered in 1018 patients (77.9%): photon-based (41.4%), proton-based (64.2%), and carbon-based (13.1%). Severe post-radiotherapy complications, mostly hypopituitarism (15.4%) and hearing loss (7.1%) were experienced by 251 patients (30.7%). Post-treatment symptom-improvement (46.7%) and reduced/stable tumor volumes (85.4%) showed no differences based on radiotherapy-protocols (p = 0.165; p = 0.062). Median follow-up was 67-months (range, 0.1–376). SBCs recurrences were reported in 211 cases (16.1%). The 5-year and 10-year progression-free survival rates were 84.3% and 67.4%, and overall survival rates were 94% and 84%. Conclusion: Surgical-resection and radiotherapy are effective treatments in primary SBCs, with acceptable complication rates and favorable local tumor control.
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Soule E, Baig S, Fiester P, Holtzman A, Rutenberg M, Tavanaiepour D, Rao D. Current Management and Image Review of Skull Base Chordoma: What the Radiologist Needs to Know. J Clin Imaging Sci 2021; 11:46. [PMID: 34513210 PMCID: PMC8422542 DOI: 10.25259/jcis_139_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/14/2021] [Indexed: 11/04/2022] Open
Abstract
Chordomas of the skull-base are typically slow-growing, notochord-derived tumors that most commonly originate along the clivus. Skull base chordoma is treated with surgery and radiotherapy. Local recurrence approaches 50% at 10 years. Radiologists play a critical role in diagnosis, treatment planning, and follow-up. Surgeons and radiation oncologists rely on radiologists for pre-operative delineation of tumor and adjacent anatomy, identification of post-treatment changes and disease recurrence, and radiation treatment effects. This review provides an overview of clinical characteristics, surgical anatomy, indications for radiotherapy, identification of treatment complications, and patterns of disease recurrence for radiologists to provide value in the management of these lesions.
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Affiliation(s)
- Erik Soule
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Saif Baig
- Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Peter Fiester
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Adam Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Michael Rutenberg
- 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
| | - Dinesh Rao
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
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Hasegawa H, Vakharia K, Graffeo CS, Carlson ML, Pollock BE, Brown PD, Perry A, Van Gompel JJ, Driscoll CLW, Link MJ. Long-term outcomes of grade I/II skull base chondrosarcoma: an insight into the role of surgery and upfront radiotherapy. J Neurooncol 2021; 153:273-281. [PMID: 33907967 DOI: 10.1007/s11060-021-03764-0] [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: 03/06/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To clarify the need for post-operative radiation treatment in skull base chondrosarcomas (SBCs). METHODS A retrospective analysis of patients with grade I or II SBC. Patients were divided according to post-surgical treatment strategies: (A) planned upfront radiotherapy and (B) watchful waiting. Tumor control and survival were compared between the treatment groups. The median follow-up after resection was 105 months (range, 9-376). RESULTS Thirty-two patients (Grade 1, n = 16; Grade 2, n = 16) were included. The most frequent location was petroclival (21, 64%). A gross total resection (GTR) was achieved in 11 patients (34%). Fourteen (44%) underwent upfront radiotherapy (group A) whereas 18 (56%) were followed with serial MRI alone (group B). The tumor control rate for the entire group was 77% and 69% at 10- and 15-year, respectively. Upfront radiotherapy (P = 0.25), extent of resection (P = 0.11) or tumor grade (P = 0.83) did not affect tumor control. The majority of Group B patients with recurrent tumors (5/7) obtained tumor control with repeat resection (n = 2), salvage radiotherapy (n = 2), or a combination of both (n = 1). The 10-year disease-specific survival was 95% with no difference between the group A and B (P = 0.50). CONCLUSION For patients with grade I/II SBC, a reasonable strategy is deferral of radiotherapy after maximum safe resection until tumor progression or recurrence. At that time, most patients can be successfully managed with salvage radiotherapy or surgery. Late recurrences may occur, and life-long follow-up is advisable.
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Affiliation(s)
- Hirotaka Hasegawa
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Kunal Vakharia
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Bruce E Pollock
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Paul D Brown
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Avital Perry
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Michael J Link
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
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7
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Abunimer A, Aiken A, Baugnon K, Wu X. Central Skull Base Anatomy and Pathology: A Review. Semin Ultrasound CT MR 2021; 42:266-280. [PMID: 34147162 DOI: 10.1053/j.sult.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The central skull base is an anatomically complex region of the head and neck which hosts a variety of neoplastic, vascular, infectious, inflammatory, and developmental pathologies. Evaluation of its intricate anatomy requires dedicated and complementary imaging modalities of MRI and CT. This article will provide a brief review of the anatomy of the central skull base, followed by an overview of common pathologies encountered in this region and their characteristic radiological characteristics.
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Affiliation(s)
- Ayman Abunimer
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA
| | - Kristen Baugnon
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA
| | - Xin Wu
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA.
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8
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Venteicher AS, McDowell MM, Goldschmidt E, Wang EW, Snyderman CH, Gardner PA. A preoperative risk classifier that predicts tumor progression in patients with cranial base chondrosarcomas. J Neurosurg 2021; 134:457-465. [PMID: 31923886 DOI: 10.3171/2019.10.jns191672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a study to identify clinical features of cranial base chondrosarcomas that will predict tumor progression after resection. METHODS The authors performed a retrospective study at a tertiary referral cranial base center. Patients who underwent resection of cranial base chondrosarcomas between January 2004 and December 2018 were followed longitudinally. The main outcome measure was progression-free survival (PFS). RESULTS A total of 41 patients were treated for histopathologically proven "conventional" cranial base chondrosarcomas during the study period, and the median PFS was 123 months for the cohort. Univariate analysis was performed on clinical, anatomical, and radiographic parameters collected for each patient. Features that were statistically significant were fed into a multivariate regression model, which revealed two independent predictors of PFS: patient age and encasement of 3-4 major arteries (> 25% of the vessel wall surrounded by tumor). Using these two variables of age and multiple arterial vessel encasement, the authors generated a risk stratification model using a simple point system to predict PFS in patients with cranial base chondrosarcomas. Based on these two factors known preoperatively, this model could stratify patients into high-risk (10% of patients), intermediate-risk (68% of patients), and low-risk (22% of patients) subgroups corresponding to dramatically distinct median PFS (1.8 years, 10.2 years, and no progression, respectively). CONCLUSIONS In patients with cranial base chondrosarcomas, age and artery encasement are variables known preoperatively that can powerfully predict tumor progression, define operative goals, and aid in selecting postoperative adjuvant therapy.
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Affiliation(s)
- Andrew S Venteicher
- Departments of1Neurological Surgery and
- 3Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Eric W Wang
- 2Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | - Carl H Snyderman
- 2Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
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9
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Raza SM, Gidley PW, Kupferman ME, Hanna EY, Su SY, DeMonte F. Site-Specific Considerations in the Surgical Management of Skull Base Chondrosarcomas. Oper Neurosurg (Hagerstown) 2019; 14:611-619. [PMID: 28962038 DOI: 10.1093/ons/opx171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/04/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Numerous approaches have been reported in the management of skull base chondrosarcomas. Data are lacking for surgical outcomes by the tumor site of origin. OBJECTIVE To provide insight into outcomes by site of origin and factors affecting resection in order to aid in surgical approach selection. METHODS A retrospective review was conducted of 49 patients with chondrosarcoma treated at our institution. Charts were reviewed for tumor- and treatment-related factors. Extent of resection was the primary outcome, while neurological function and surgical complications were secondary outcomes. Statistical analyses were performed assessing variables for their impact on the primary outcome. RESULTS The gross total resection rate for the overall cohort was 67.3%, and 97.8% of patients were either neurologically stable or improved postoperatively. A petroclival site of origin had lower rates of resection vs all other sites (P < .05). Histology and previous surgery did not predict outcome (P > .05), while previous radiotherapy and cavernous sinus invasion correlated with a subtotal resection (P < .05). In the petroclival cohort, clival, jugular tubercle, and soft tissue involvement correlated with a subtotal resection (P < .05). An endoscopic endonasal transpterygoid approach alone or combined with a transcranial approach yielded the highest resection rates for petroclival tumors (P < .05). CONCLUSION Chondrosarcomas pose unique challenges based on the site of origin and pattern of extension. While current surgical strategies appear to yield adequate results at a majority of skull base sites, petroclival tumors represent a particular cohort in which improvement is needed. Based on our analysis, strategies incorporating both endoscopic and transcranial skull base approaches are likely necessary to achieve optimal outcomes.
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Affiliation(s)
- Shaan M Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul W Gidley
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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10
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Vaz-Guimaraes F, Fernandez-Miranda JC, Koutourousiou M, Hamilton RL, Wang EW, Snyderman CH, Gardner PA. Endoscopic Endonasal Surgery for Cranial Base Chondrosarcomas. Oper Neurosurg (Hagerstown) 2019; 13:421-434. [PMID: 28838112 DOI: 10.1093/ons/opx020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/24/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Microsurgical resection via open approaches is considered the main treatment modality for cranial base chondrosarcomas (CBCs). The use of endoscopic endonasal approaches (EEAs) has been rarely reported. OBJECTIVE To present the endoscopic endonasal experience with CBCs at our institution. METHODS Retrospective review of the medical records of 35 consecutive patients who underwent EEA for CBC resection between January 2004 and April 2013. Surgical outcomes and variables that might affect extent of resection, complications, and recurrence were analyzed. RESULTS Forty-eight operations were performed (42 EEAs and 6 open approaches). Gross-total resection was achieved in 22 patients (62.9%), near total (≥90% tumor resection) in 11 (31.4%). Larger tumors were associated with incomplete resection in univariate and multivariate analysis ( P = .004, .015, respectively). In univariate analysis, tumors involving the lower clivus and cerebellopontine angle were associated with increased number of complications, especially postoperative cerebrospinal fluid leak ( P = .015) and new cranial neuropathy ( P = .037), respectively. Other major complications included 2 cases of meningitis and deep venous thrombosis, and 1 case of hydrocephalus and carotid injury. Involvement of the lower clivus, parapharyngeal space, and cervical spine required a combination of approaches to maximize tumor resection ( P = .017, .044, .017, respectively). No predictors were significantly associated with increased risk of recurrence. The average follow-up time was 44.6 ± 31 months. CONCLUSIONS EEAs may be considered a good option for managing CBCs without significant posterolateral extension beyond the basal foramina and can be used in conjunction with open approaches for maximal resection with acceptable morbidity.
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Affiliation(s)
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maria Koutourousiou
- Department of Neurolog-ical Surgery, University of Louisville, Louisville, Kentucky
| | | | - Eric W Wang
- Department of Oto-laryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl H Snyderman
- Department of Oto-laryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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11
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Mehta GU, DeMonte F, Su SY, Kupferman ME, Hanna EY, Raza SM. Endoscopic endonasal transpterygoid transnasopharyngeal management of petroclival chondrosarcomas without medial extension. J Neurosurg 2019; 131:184-191. [PMID: 30074455 DOI: 10.3171/2018.3.jns172722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/01/2018] [Indexed: 11/06/2022]
Abstract
Chondrosarcomas of the skull base are malignant tumors for which surgery is the primary therapeutic option. Gross-total resection has been demonstrated to improve survival in patients with these tumors. Chondrosarcomas arising from the petroclival synchondrosis harbor particularly unique anatomical considerations that have long been a barrier to achieving such a resection. Endoscopic endonasal transpterygoid approaches have been recently used to gain improved access to such lesions; however, these approaches have classically relied on a medial to lateral transclival trajectory, which provides limited exposure for complete resection of lateral disease. In this paper the authors describe an endoscopic endonasal transpterygoid transnasopharyngeal approach that provides comprehensive access to the petroclival region through dissection of the eustachian tube with resection of the cartilaginous torus tubarius. Of note, the authors have previously demonstrated the superior outcomes and validity of this approach relative to other cranial base techniques for petroclival chondrosarcomas. Surgical outcomes in 5 cases of chondrosarcoma without medial extension are detailed. Gross-total resection was achieved in 4 of 5 patients. Postoperative complications included transient palatal numbness in all patients and eustachian tube dysfunction due to the approach. With tympanostomy tube placement, no patient had persistent hearing loss. Overall, this approach appears to be a safe and effective technique for resection of petroclival chondrosarcomas.
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Affiliation(s)
| | | | - Shirley Y Su
- 2Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- 2Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- 2Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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12
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Gatfield ER, Noble DJ, Barnett GC, Early NY, Hoole ACF, Kirkby NF, Jefferies SJ, Burnet NG. Tumour Volume and Dose Influence Outcome after Surgery and High-dose Photon Radiotherapy for Chordoma and Chondrosarcoma of the Skull Base and Spine. Clin Oncol (R Coll Radiol) 2019; 30:243-253. [PMID: 29402600 DOI: 10.1016/j.clon.2018.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the long-term outcomes of patients with chordoma and low-grade chondrosarcoma after surgery and high-dose radiotherapy. MATERIALS AND METHODS High-dose photon radiotherapy was delivered to 28 patients at the Neuro-oncology Unit at Addenbrooke's Hospital (Cambridge, UK) between 1996 and 2016. Twenty-four patients were treated with curative intent, 17 with chordoma, seven with low-grade chondrosarcoma, with a median dose of 65 Gy (range 65-70 Gy). Local control and survival rates were calculated using the Kaplan-Meier method. RESULTS The median follow-up was 83 months (range 7-205 months). The 5 year disease-specific survival for chordoma patients treated with radical intent was 85%; the local control rate was 74%. The 5 year disease-specific survival for chondrosarcoma patients treated with radical intent was 100%; the local control rate was 83%. The mean planning target volume (PTV) was 274.6 ml (median 124.7 ml). A PTV of 110 ml or less was a good predictor of local control, with 100% sensitivity and 63% specificity. For patients treated with radical intent, this threshold of 110 ml or less for the PTV revealed a statistically significant difference when comparing local control with disease recurrence (P = 0.019, Fisher's exact test). Our data also suggest that the probability of disease control may be partly related to both target volume and radiotherapy dose. CONCLUSION Our results show that refined high-dose photon radiotherapy, following tumour resection by a specialist surgical team, is effective in the long-term control of chordoma and low-grade chondrosarcoma, even in the presence of metal reconstruction. The results presented here will provide a useful source for comparison between high-dose photon therapy and proton beam therapy in a UK setting, in order to establish best practice for the management of chordoma and low-grade chondrosarcoma.
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Affiliation(s)
- E R Gatfield
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
| | - D J Noble
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - G C Barnett
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - N Y Early
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - A C F Hoole
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - N F Kirkby
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - S J Jefferies
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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Banaz F, Edem I, Moldovan ID, Kilty S, Jansen G, Alkherayf F. Chondrosarcoma in the Petrous Apex: Case Report and Review. J Neurol Surg Rep 2018; 79:e83-e87. [PMID: 30473986 PMCID: PMC6193802 DOI: 10.1055/s-0038-1673627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/28/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Surgical treatment of petrous apex chondrosarcoma is challenging due to the location of the tumor. Using an endoscopic technique for tumor resection is favored since it provides a minimally invasive approach. Case Presentation A 57 years old female was admitted for acute onset of left abducens nerve palsy and occasional headache mainly on the left side of the retro-orbital area with some radiation to the left occiput. Magnetic resonance imaging (MRI) and computed tomography (CT), at the time of admission, were showed lytic lesion on the left petrous apex and left part of the clivus. Results of metastatic workup were negative. The surgical procedure considered was expanded endoscopic endonasal transclival approach to the left of the petrous apex and reconstruction with a pedicled nasoseptal flap with image guidance system. The pathology confirmed chondrosarcoma on myxoid background. The surgical procedure was uncomplicated. The abducens nerve palsy was resolved in few weeks and no new deficits occurred. Postoperative MRI showed complete resection of the tumor. Conclusion Expanded endoscopic endonasal transclival approach to petrous apex and reconstruction appears to be safe and feasible technique, capable of achieving total removal of identified lesions near the petrous apex. Nonetheless, future studies with a greater number of patients are crucial to confirm and consolidate this initial impression.
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Affiliation(s)
- F. Banaz
- Department of Otolaryngology- Head & Neck Surgery, The Ottawa Hospital, Ottawa, Canada
| | - I. Edem
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
| | - I. D. Moldovan
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - S. Kilty
- Department of Otolaryngology- Head & Neck Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - G. Jansen
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
| | - F. Alkherayf
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
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Leah P, Dower A, Vescovi C, Mulcahy M, Al Khawaja D. Clinical experience of intracranial chordoma – A systematic review and meta-analysis of the literature. J Clin Neurosci 2018; 53:6-12. [DOI: 10.1016/j.jocn.2018.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/09/2018] [Indexed: 01/31/2023]
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Proposed Treatment Paradigm for Intracranial Chondrosarcomas Based on Multidisciplinary Coordination. World Neurosurg 2017; 109:e517-e530. [PMID: 29033377 DOI: 10.1016/j.wneu.2017.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES There was no consensus regarding the treatment of intracranial chondrosarcoma (CSA). The study aimed to evaluate the adverse factors for progression-free survival (PFS) and overall survival (OS) and to propose a treatment strategy for CSA. METHODS The clinical chart and radiographic data of 106 consecutive cases (mesenchymal and conventional CSA in 18 and 88 patients, respectively) of surgically treated CSAs were retrospectively reviewed. RESULTS Gross total resection was achieved in 43 patients (40.6%), and adjuvant radiotherapy was administered in 45 patients. After a mean follow-up duration of 47.8 months, 38 patients (37.3%) experienced recurrence. PFS and disease-specific OS at 5 years was 57.7% and 74.4%. Independent adverse factors for PFS were previous surgery (hazard ratio [HR] 2.261; P = 0.028), increased lesion size (HR, 1.298; P = 0.026), extent of surgical resection (HR, 3.226; P < 0.001), malignant pathology (HR, 2.018; P = 0.003), and postoperative radiotherapy (HR, 3.246; P = 0.001). The stereotactic radiosurgery subgroup presented best 5-year PFS of 88.9%, and a linear accelerator prolonged the mean PFS time (57.0 months) compared with no radiation (38.1 months). In the incomplete resection subgroup (n = 63), radiotherapy significantly benefited tumor control (HR, 2.101; P = 0.016). Extent of surgical resection (HR, 1.797; P = 0.026) and malignant disease (HR, 1.717; P = 0.030) were associated with OS. CONCLUSIONS Intracranial CSAs were not completely amendable by surgery alone. Gross total resection as far as possible plus radiation were necessary for mesenchymal CSA and conventional CSA with active growth or residual tumor. Stereotactic radiosurgery was an alternative if proton therapy was unavailable. A future study with a large cohort is required to verify our findings.
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Hasegawa H, Shin M, Kondo K, Hanakita S, Mukasa A, Kin T, Saito N. Role of endoscopic transnasal surgery for skull base chondrosarcoma: a retrospective analysis of 19 cases at a single institution. J Neurosurg 2017; 128:1438-1447. [PMID: 28686110 DOI: 10.3171/2017.1.jns162000] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Skull base chondrosarcoma is one of the most intractable tumors because of its aggressive biological behavior and involvement of the internal carotid artery and cranial nerves (CNs). One of the most accepted treatment strategies for skull base chondrosarcoma has been surgical removal of the tumor in conjunction with proactive extensive radiation therapy (RT) to the original tumor bed. However, the optimal strategy has not been determined. The goal of this study was to evaluate the early results of endoscopic transnasal surgery (ETS). METHODS The authors retrospectively analyzed 19 consecutive patients who underwent ETS at their institution since 2010. Adjuvant stereotactic radiosurgery (SRS) was performed only for the small residual tumors that were not resected to avoid critical neurological complications. Histological confirmation and evaluation of the MIB-1 index was performed in all cases. The Kaplan-Meier method was used to determine the actuarial rate of tumor-free survival. RESULTS The median tumor volume and maximal diameter were 14.5 cm3 (range 1.4-88.4 cm3) and 3.8 cm (range 1.5-6.7 cm), respectively. Nine patients (47%) had intradural extension of the tumor. Gross-total resection was achieved in 15 (78.9%) of the 19 patients, without any disabling complications. In 4 patients, the surgery resulted in subtotal (n = 2, 11%) or partial (n = 2, 11%) resection because the tumors involved critical structures, including the basilar artery or the lower CNs. These 4 patients were additionally treated with SRS. The median follow-up duration was 47, 28, and 27 months after the diagnosis, ETS, and SRS, respectively. In 1 patient with an anterior skull base chondrosarcoma, the tumor relapsed in the optic canal 1 year later and was treated with a second ETS. Favorable tumor control was achieved in all other patients. The actuarial tumor control rate was 93% at 5 years. At the final follow-up, all patients were alive and able to perform independent activities of daily living without continuous neurological sequelae. CONCLUSIONS These preliminary results suggest that ETS can achieve sufficient radical tumor removal, resulting in comparative resection rates with fewer neurological complications to those in previous reports. Although the follow-up periods of these cases were relatively short, elective SRS to the small tumor remnant may be rational, achieving successful tumor control in some cases, instead of using proactive extensive RT. Thus, the addition of RT should be discussed with each patient, after due consideration of histological grading and biological behavior. To determine the efficacy of this strategy, a larger case series with a longer follow-up period is essential. However, this strategy may be able to establish evidence in the management of skull base chondrosarcoma, providing less-invasive and effective options as an initial step of treatment.
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Affiliation(s)
| | | | - Kenji Kondo
- 2Otorhinolaryngology, University of Tokyo Hospital, Tokyo, Japan
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17
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Raza SM, Gidley PW, Meis JM, Grosshans DR, Bell D, DeMonte F. Multimodality Treatment of Skull Base Chondrosarcomas: The Role of Histology Specific Treatment Protocols. Neurosurgery 2017; 81:520-530. [DOI: 10.1093/neuros/nyx042] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Limited data exist to guide the multimodality management of chondrosarcomas (CSAs) arising in the skull base.
OBJECTIVE: To determine the impact of histological subtype/grade on progression-free survival (PFS) and the indications for surgery, radiation, and chemotherapy based on histology.
METHODS: A retrospective review was performed of 37 patients (conventional type: 81%, mesenchymal: 16.2%, dedifferentiated: 2.7%) treated at The University of Texas M.D. Anderson Cancer Center. Of the conventional subtype, 23% were grade 1, 63% were grade 2, and 14% were grade 3. In addition to surgery, mesenchymal/dedifferentiated CSAs (18% of the cohort) underwent neoadjuvant chemotherapy and 48.6% of the overall cohort received adjuvant radiotherapy. Histological grade/subtype and treatment factors were assessed for impact on median PFS (primary outcome).
RESULTS: Conventional subtype vs mesenchymal/dedifferentiated was positively associated with median PFS (166 vs 24 months, P < .05). Increasing conventional grade inversely correlated with median PFS (P < .05). Gross total resection positively impacted PFS in conventional CSAs (111.8 vs 42.9 months, P = .201) and mesenchymal/dedifferentiated CSAs (58.2 vs 1.0 month, P < .05). Adjuvant radiotherapy significantly impacted PFS in conventional grades 2 and 3 (182 vs 79 months, P < .05) and a positive trend with mesenchymal/dedifferentiated CSAs (43.5 vs 22.0 months). Chemotherapy improved PFS for mesenchymal/dedifferentiated CSAs (50 vs 9 months, P = .089).
CONCLUSION: There is a potential need for histological subtype/grade specific treatment protocols. For conventional CSAs, surgery alone provides optimal results grade 1 CSAs, while resection with adjuvant radiotherapy yields the best outcome for grade 2 and 3 CSAs. Improvements in PFS seen with neoadjuvant therapy in mesenchymal/dedifferentiated CSAs indicate a potential role for systemic therapies. Larger studies are necessary to confirm the proposed treatment protocols.
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Affiliation(s)
- Shaan M. Raza
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Paul W. Gidley
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jeanne M. Meis
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - David R. Grosshans
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Diana Bell
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Spontaneous Intraventricular Hemorrhage: A Rare Presentation of a Skull Base Mesenchymal Chondrosarcoma. World Neurosurg 2017; 99:811.e1-811.e5. [DOI: 10.1016/j.wneu.2016.12.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022]
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Miller M, Pearl MS, Wyse E, Olivi A, Francis HW. Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis. J Neurol Surg B Skull Base 2016; 77:249-59. [PMID: 27175321 DOI: 10.1055/s-0035-1566302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/10/2015] [Indexed: 10/22/2022] Open
Abstract
Objectives To describe an enhanced infralabyrinthine approach to petroclival lesions with jugular bulb decompression, and to quantify surgical access using a flat-panel computed tomography image protocol. Design Retrospective case series and paired comparison of pre- versus post-dissection anatomy. Setting Tertiary academic medical center. Participants Four patients presenting with petroclival lesions. Six fresh cadaveric specimens were used for temporal bone dissection. Main Outcome Measures Axial and coronal dimensions, and access angles of the infralabyrinthine surgical corridor. Results Decompression of the jugular bulb increased the craniocaudal width of the infralabyrinthine corridor from 0.9 to 7.9 mm to 6.5 to 11.6 mm. The mean increase of 4 mm was statistically significant (t = 3.7; p < .05). There was also a significant widening of the infralabyrinthine window along the axial dimension by 0.9 to 4.5 mm or a mean of 2 mm (t = 3.7; p < .05). Angles of access to the petroclival region were wider following jugular bulb decompression, particularly in the coronal plane (mean difference 7.9 degrees; t = 5.0; p < .005) but less so in the axial plane (mean difference 4.7 degrees; t = 2.5; p = .05). Conclusions Jugular bulb decompression enhances infralabyrinthine access to petroclival lesions, permitting the removal of tissue for diagnoses or partial resection, without significant additional morbidity.
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Affiliation(s)
- Matthew Miller
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Monica S Pearl
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Emily Wyse
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alessandro Olivi
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Howard W Francis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
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20
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Feuvret L, Bracci S, Calugaru V, Bolle S, Mammar H, De Marzi L, Bresson D, Habrand JL, Mazeron JJ, Dendale R, Noël G. Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study. Int J Radiat Oncol Biol Phys 2016; 95:312-321. [DOI: 10.1016/j.ijrobp.2015.12.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/17/2015] [Accepted: 12/02/2015] [Indexed: 11/26/2022]
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Müller U, Kubik-Huch RA, Ares C, Hug EB, Löw R, Valavanis A, Ahlhelm FJ. Is there a role for conventional MRI and MR diffusion-weighted imaging for distinction of skull base chordoma and chondrosarcoma? Acta Radiol 2016; 57:225-32. [PMID: 25722460 DOI: 10.1177/0284185115574156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chordoma and chondrosarcoma are locally invasive skull base tumors with similar clinical symptoms and anatomic imaging features as reported in the literature. PURPOSE To determine differentiation of chordoma and chondrosarcoma of the skull base with conventional magnetic resonance imaging (cMRI) and diffusion-weighted MR imaging (DWI) in comparison to histopathological diagnosis. MATERIAL AND METHODS This retrospective study comprised 96 (chordoma, n = 64; chondrosarcoma, n = 32) patients with skull base tumors referred to the Paul Scherrer Institute (PSI) for proton therapy. cMRI signal intensities of all tumors were investigated. In addition, median apparent diffusion coefficient (ADC) values were measured in a subgroup of 19 patients (chordoma, n = 11; chondrosarcoma, n = 8). RESULTS The majority 81.2% (26/32) of chondrosarcomas displayed an off-midline growth pattern, 18.8% (6/32) showed clival invasion, 18.8% (6/32) were located more centrally. Only 4.7% (3/64) of chordomas revealed a lateral clival origin. Using cMRI no significant differences in MR signal intensities were observed in contrast to significantly different ADC values (subgroup of 19/96 patients examined by DWI), with the highest mean value of 2017.2 × 10(-6 )mm(2)/s (SD, 139.9( )mm(2)/s) for chondrosarcoma and significantly lower value of 1263.5 × 10(-6 )mm(2)/s (SD, 100.2 × 10(-6 )mm(2)/s) for chordoma (P = 0.001/median test). CONCLUSION An off-midline growth pattern can differentiate chondrosarcoma from chordoma on cMRI in a majority of patients. Additional DWI is a promising tool for the differentiation of these skull base tumors.
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Affiliation(s)
- Uta Müller
- Department of Radiology, Kantonsspital Baden AG, Switzerland
| | | | - Carmen Ares
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Eugen B Hug
- Princton Radiation Oncology Center, Monroe Township, NJ, USA
| | - Roland Löw
- Department of Radiology, Kantonsspital Baden AG, Switzerland
| | | | - Frank J Ahlhelm
- Department of Radiology, Kantonsspital Baden AG, Switzerland
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Awad M, Gogos AJ, Kaye AH. Skull base chondrosarcoma. J Clin Neurosci 2015; 24:1-5. [PMID: 26724847 DOI: 10.1016/j.jocn.2015.10.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 10/31/2015] [Indexed: 11/16/2022]
Abstract
Intracranial chondrosarcoma are rare tumours, accounting for approximately one in 1000 intracranial neoplasms. Although more common in the axial or appendicular skeleton, intracranial tumours present a challenging surgical and oncological problem. Chondrosarcoma have a predilection for the skull base and although commonly slow growing, Grade II and III lesions do occur. We present two illustrative patients from the Royal Melbourne Hospital, Australia, demonstrating dramatically differing presentation and clinical outcome and the diagnostic difficulties that may arise. A review of the literature regarding skull base chondrosarcoma is presented. We summarise the clinical, radiological and histological features. The evidence for surgical resection, radiotherapy and chemotherapy is presented and critically evaluated. Based on the available evidence, we advocate maximal safe resection, followed by radiotherapy for Grade II and III tumours. There is no current role for chemotherapy. Radical excision should not be attempted at the expense of neurological function.
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Affiliation(s)
- Mohammed Awad
- Department of Neurosurgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 305, Australia.
| | - Andrew James Gogos
- Department of Neurosurgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 305, Australia; Department of Surgery, The University of Melbourne, VIC, Australia
| | - Andrew H Kaye
- Department of Neurosurgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 305, Australia; Department of Surgery, The University of Melbourne, VIC, Australia
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Beer-Furlan A, Balsalobre L, Vellutini EAS, Stamm AC. Endoscopic Endonasal Approach in Skull Base Chondrosarcoma Associated with Maffucci Syndrome: Case Series and Literature Review. World Neurosurg 2015; 85:365.e7-15. [PMID: 26348567 DOI: 10.1016/j.wneu.2015.08.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Maffucci syndrome is a nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. The potential malignant progression of enchondroma into a secondary chondrosarcoma is a well-known fact. Nevertheless, chondrosarcoma located at the skull base in patients with Maffuci syndrome is a very rare condition, with only 18 cases reported in the literature. CASE DESCRIPTION We report 2 other cases successfully treated through an expanded endoscopic endonasal approach and discuss the condition based on the literature review. CONCLUSIONS Skull base chondrosarcoma associated with Maffucci syndrome is a rare condition. The disease cannot be cured, therefore surgical treatment should be performed in symptomatic patients aiming for maximal tumor resection with function preservation. The endoscopic endonasal approach is a safe and reliable alternative for the management of these tumors.
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Affiliation(s)
- André Beer-Furlan
- São Paulo Skull Base Center, São Paulo, Brazil; DFVneuro Neurosurgical Group, São Paulo, Brazil.
| | - Leonardo Balsalobre
- São Paulo Skull Base Center, São Paulo, Brazil; São Paulo ENT Center, Professor Edmundo Vasconcelos Hospital, São Paulo, Brazil
| | - Eduardo A S Vellutini
- São Paulo Skull Base Center, São Paulo, Brazil; DFVneuro Neurosurgical Group, São Paulo, Brazil
| | - Aldo C Stamm
- São Paulo Skull Base Center, São Paulo, Brazil; São Paulo ENT Center, Professor Edmundo Vasconcelos Hospital, São Paulo, Brazil
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Kano H, Sheehan J, Sneed PK, McBride HL, Young B, Duma C, Mathieu D, Seymour Z, McDermott MW, Kondziolka D, Iyer A, Lunsford LD. Skull base chondrosarcoma radiosurgery: report of the North American Gamma Knife Consortium. J Neurosurg 2015; 123:1268-75. [PMID: 26115468 DOI: 10.3171/2014.12.jns132580] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Stereotactic radiosurgery (SRS) is a potentially important option for patients with skull base chondrosarcomas. The object of this study was to analyze the outcomes of SRS for chondrosarcoma patients who underwent this treatment as a part of multimodality management. METHODS Seven participating centers of the North American Gamma Knife Consortium (NAGKC) identified 46 patients who underwent SRS for skull base chondrosarcomas. Thirty-six patients had previously undergone tumor resections and 5 had been treated with fractionated radiation therapy (RT). The median tumor volume was 8.0 cm3 (range 0.9-28.2 cm3), and the median margin dose was 15 Gy (range 10.5-20 Gy). Kaplan-Meier analysis was used to calculate progression-free and overall survival rates. RESULTS At a median follow-up of 75 months after SRS, 8 patients were dead. The actuarial overall survival after SRS was 89% at 3 years, 86% at 5 years, and 76% at 10 years. Local tumor progression occurred in 10 patients. The rate of progression-free survival (PFS) after SRS was 88% at 3 years, 85% at 5 years, and 70% at 10 years. Prior RT was significantly associated with shorter PFS. Eight patients required salvage resection, and 3 patients (7%) developed adverse radiation effects. Cranial nerve deficits improved in 22 (56%) of the 39 patients who deficits before SRS. Clinical improvement after SRS was noted in patients with abducens nerve paralysis (61%), oculomotor nerve paralysis (50%), lower cranial nerve dysfunction (50%), optic neuropathy (43%), facial neuropathy (38%), trochlear nerve paralysis (33%), trigeminal neuropathy (12%), and hearing loss (10%). CONCLUSIONS Stereotactic radiosurgery for skull base chondrosarcomas is an important adjuvant option for the treatment of these rare tumors, as part of a team approach that includes initial surgical removal of symptomatic larger tumors.
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Affiliation(s)
- Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Penny K Sneed
- Departments of Radiation Oncology and Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Heyoung L McBride
- Departments of Radiation Oncology and Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Byron Young
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky
| | - Christopher Duma
- Department of Neurological Surgery, Hoag Memorial Hospital, Newport Beach, California
| | - David Mathieu
- Department of Neurological Surgery, Université de Sherbrooke, Centre de Recherche Clinique Étienne-LeBel, Sherbrooke, Quebec, Canada
| | - Zachary Seymour
- Departments of Radiation Oncology and Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Michael W McDermott
- Departments of Radiation Oncology and Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Douglas Kondziolka
- Department of Neurological Surgery, New York University Langone Medical Center, New York, New York; and
| | - Aditya Iyer
- Department of Neurological Surgery, Stanford University, Stanford, California
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Iyer A, Kano H, Kondziolka D, Liu X, Flickinger JC, Lunsford LD. Postsurgical management strategies in patients with skull base chondrosarcomas. CNS Oncol 2015; 2:203-8. [PMID: 25057979 DOI: 10.2217/cns.13.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Chondrosarcomas of the skull base are rare, slow-growing tumors that are often lethal and remain a management quandary. A systematic review was performed to understand postsurgical management options for patients with these tumors. The current standard of care includes surgical resection followed by either adjuvant radiation therapy and/or early radiosurgery. The role of chemotherapy has been limited, but remains under investigation. Overall survival and progression-free survival range between 70 and 100% at 5 years when multimodality approaches are used. Overall survival may be greater for patients who have a shorter interval (<6 months) between diagnosis and radiosurgery, an older age, and either a single or no prior resection. Progression-free survival may be increased for patients older than 40 years of age, who have not had prior radiation therapy, and for those with smaller tumors that do not compress the brainstem.
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Affiliation(s)
- Aditya Iyer
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Moussazadeh N, Kulwin C, Anand VK, Ting JY, Gamss C, Iorgulescu JB, Tsiouris AJ, Cohen-Gadol AA, Schwartz TH. Endoscopic endonasal resection of skull base chondrosarcomas: technique and early results. J Neurosurg 2015; 122:735-42. [PMID: 25594323 DOI: 10.3171/2014.11.jns14827] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors of this study sought to report the technique and early clinical outcomes of a purely endonasal endoscopic approach for resection of petroclival chondrosarcomas. METHODS Between 2010 and 2014, 8 patients (4 men and 4 women) underwent endonasal endoscopic operations to resect petroclival chondrosarcomas at 2 institutions. The patients' mean age was 44.8 years (range 30-64 years). One of the patients had previously undergone radiation therapy and another a staged craniotomy. Using volumetric software, an independent neuroradiologist assessed the extent of the resections on MRI scans taken immediately after surgery and at the 3-month follow-up. Immediate complications and control of symptoms were also recorded. In addition, the authors reviewed the current literature on surgical treatment of chondrosarcoma. RESULTS The mean preoperative tumor diameter and volume were 3.4 cm and 9.8 cm(3), respectively. Six patients presented with cranial neuropathies. Endonasal endoscopic surgery achieved > 95% resection in 5 of the 8 patients and < 95% resection in the remaining 3 patients. One of the 6 neuropathies resolved, and the remaining 5 partially improved. One instance of postoperative CSF leakage required a reoperation for repair; no other complications associated with these operations were observed. All of the patients underwent adjuvant radiotherapy. CONCLUSIONS According to the authors' experience, the endoscopic endonasal route is a safe and effective approach for the resection of appropriately selected petroclival chondrosarcomas.
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Rombi B, Timmermann B. Proton Beam Therapy for Pediatric Chordomas: State of the Art. Int J Part Ther 2014. [DOI: 10.14338/ijpt.13.00008.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kano H, Iyer A, Lunsford LD. Skull Base Chondrosarcoma Radiosurgery: A Literature Review. Neurosurgery 2014; 61 Suppl 1:155-8. [DOI: 10.1227/neu.0000000000000382] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aditya Iyer
- Department of Neurosurgery, Stanford University, Stanford, California
| | - L. Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Geng S, Zhang J, Zhang LW, Wu Z, Jia G, Xiao X, Hao S. Diagnosis and microsurgical treatment of chondromas and chondrosarcomas of the cranial base. Oncol Lett 2014; 8:301-304. [PMID: 24959265 PMCID: PMC4063631 DOI: 10.3892/ol.2014.2072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 03/06/2014] [Indexed: 11/28/2022] Open
Abstract
Chondromas and chondrosarcomas of the cranial base are rare neoplastic diseases. The aim of the present study was to evaluate the diagnosis and microsurgical treatment of these difficult cranial base tumors. A total of 19 patients who underwent microsurgery were pathologically diagnosed with cranial base chondromas or chondrosarcomas and their clinical data was reviewed. The chondromas and chondrosarcomas of the cranial base in the present study commonly originated in the sphenopetrosal, sphenoclival or petroclival junctions, and the majority were located in the parasellar region of the middle cranial base extradurally. The most frequent symptoms were headaches and cranial nerve palsy, and the Karnofsky performance score (KPS), assessed pre-operatively, averaged at 87.1. A frontotemporal or preauricular subtemporal-infratemporal approach was used in 11 cases, a tempo-occipital transtentorial or presigmoid supratentorial-infratentorial approach was employed in six further cases, and the far-lateral or retrosigmoid approach was applied in the remaining two cases. A total or near-total tumor removal was secured in 13 cases, while a subtotal removal was obtained in another five and a partial removal was achieved in one case. The most common post-operative complications included cranial nerve palsy and cerebrospinal fluid leakage, but there were no post-operative fatalities. A total of 15 patients were followed up for a mean of 67.2 months (range, 5–140 months), and 13 (76.5%) of these patients were living normal lives (KPS, 80–90). There were two patients with recurrent tumors. The neuroradiological examinations and the presenting symptoms and signs allow the pre-operative diagnosis to be presumed for the majority of cranial base chondromas or chondrosarcomas. Surgical resection is the key treatment for these tumors, and this treatment is known to improve the survival rates.
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Affiliation(s)
- Sumin Geng
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 100050, P.R. China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 100050, P.R. China
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 100050, P.R. China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 100050, P.R. China
| | - Guijun Jia
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 100050, P.R. China
| | - Xinru Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 100050, P.R. China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 100050, P.R. China
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Sbaihat A, Bacciu A, Pasanisi E, Sanna M. Skull base chondrosarcomas: surgical treatment and results. Ann Otol Rhinol Laryngol 2014; 122:763-70. [PMID: 24592579 DOI: 10.1177/000348941312201206] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We describe our experience in the management of patients with skull base chondrosarcoma, an uncommon neoplasm of the skull base. METHODS Thirteen cases of surgically treated skull base chondrosarcomas were identified. The patients' follow-ups ranged from 7 to 86 months (mean, 47 months). RESULTS The most common tumor locations were the jugular foramen (5 cases), the petrous apex (3 cases), and the petroclival region (3 cases). An infratemporal fossa type A approach was performed in 2 cases, and 2 patients underwent an infratemporal fossa type B approach. Two patients underwent a transotic approach, 1 patient underwent a petro-occipital transsigmoid approach, and a petro-occipital transsigmoid approach combined with a transotic approach was chosen in 1 case. One patient underwent an infratemporal fossa type C approach combined with a transotic approach, and 2 patients underwent an infratemporal fossa type B approach combined with a transotic approach. One patient underwent an infratemporal fossa type B approach combined with a transzygomatic approach, and the last patient underwent a transmastoid approach. Gross total tumor removal was achieved in all patients. Postoperative radiotherapy was performed in 7 cases. The most common complications were lower cranial nerve deficits. Two patients experienced recurrences, 36 months and 6 years after surgical removal. CONCLUSIONS We believe that the primary treatment for chondrosarcomas of the skull base is gross total surgical resection. We usually do not recommend radiotherapy as the primary treatment for patients with skull base chondrosarcomas; however, radiotherapy may be considered as an alternative primary treatment in selected cases in which there are serious medical contraindications to surgery, as well as in elderly patients. We reserve postoperative radiotherapy for patients with histologically aggressive tumors (grade II or III), as well as for cases of subtotal resection or recurrent tumors.
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Affiliation(s)
| | - Andrea Bacciu
- Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Enrico Pasanisi
- Head and Neck Department, University Hospital of Parma, Parma, Italy
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Choi D, Subramanian A, Elwell V, Andrews P, Roberts D, Gleeson M. Endoscopic transnasal surgery as a replacement for maxillotomy techniques to approach the central skull base: fewer complications and more acceptable to patients? J Neurol Surg B Skull Base 2014; 75:165-70. [PMID: 25072010 DOI: 10.1055/s-0033-1358375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/19/2013] [Indexed: 10/25/2022] Open
Abstract
Objectives To compare the complication rates of endoscopic transnasal and open maxillotomy approaches for the central skull base. Design Retrospective review. Setting Single-center study, London, United Kingdom. Participants From 1992 to 2012, 81 patients underwent surgery for skull base lesions, 59 by maxillotomy and 22 by endoscopy. Main Outcome Measures Total time of surgical anesthesia, blood loss, complications, duration of tracheal intubation, duration of hospital stay, myelopathy score, and mortality rate. Results The surgical time, blood loss, and duration of the postoperative intubation period were significantly less with endoscopy (p < 0.001). Requirements for intensive care, ward stay, and total hospital stay were also significantly less in the endoscopic group (p = 0.01, p < 0.001, and p < 0.001, respectively). The complication rate was lower with transnasal endoscopic surgery. Conclusion In patients for whom open maxillotomy or endoscopic surgery are both feasible, the preference should be to perform endoscopic surgery, with better visualization and fewer complications.
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Affiliation(s)
- David Choi
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Ashok Subramanian
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Vivian Elwell
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Peter Andrews
- Department of ENT, The Royal National Throat Nose Ear Hospital, London, United Kingdom
| | - David Roberts
- Department of ENT, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - Michael Gleeson
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom ; Department of ENT, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
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Bag AK, Chapman PR. Neuroimaging: Intrinsic Lesions of the Central Skull Base Region. Semin Ultrasound CT MR 2013; 34:412-35. [DOI: 10.1053/j.sult.2013.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kano H, Lunsford LD. Stereotactic radiosurgery of intracranial chordomas, chondrosarcomas, and glomus tumors. Neurosurg Clin N Am 2013; 24:553-60. [PMID: 24093573 DOI: 10.1016/j.nec.2013.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chordomas and chondrosarcomas are rare, slow-glowing, locally aggressive tumors with high recurrence rates. Stereotactic radiosurgery (SRS) is an important management option for patients with recurrent or residual chordomas and chondrosarcomas. Glomus jugulare tumor are rare highly vascularized tumors that arise from the paraganglionic structures of the glossopharyngeal and vagal nerves. Because of their highly vascular nature and surgically formidable anatomic location, curative resection often proves challenging. SRS can be used as an up-front treatment or as an additional treatment for patients with recurrent or residual glomus jugulare tumor after surgical resection.
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Affiliation(s)
- Hideyuki Kano
- Department of Neurological Surgery, The Center for Image-Guided Neurosurgery, UPMC Presbyterian, University of Pittsburgh School of Medicine, University of Pittsburgh, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Bloch OG, Jian BJ, Yang I, Han SJ, Aranda D, Ahn BJ, Parsa AT. Cranial chondrosarcoma and recurrence. Skull Base 2011; 20:149-56. [PMID: 21318031 DOI: 10.1055/s-0029-1246218] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The literature regarding recurrences in patients with cranial chondrosarcoma is limited to small series performed at single institutions, raising the question if these data precisely reflect the true recurrence of this tumor for guiding the clinician in the management of these patients. An extensive systematic review of the English literature was performed. The patients were stratified according to treatment modality, treatment history, histological subtype, and histological grade, and the recurrence rates were analyzed. A total of 560 patients treated for cranial chondrosarcoma were included. Five-year recurrence rate among all patients was 22% with median follow-up of 60 months and median disease-free interval of 16 months. Tumor recurrence was more common in patients who only received surgery or had mesenchymal subtype tumors. Our systematic review closely reflects the actuarial recurrence rate and provides predictive factors in the recurrence of cranial chondrosarcoma.
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Affiliation(s)
- Orin G Bloch
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
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Rhomberg W. The radiation response of sarcomas by histologic subtypes: a review with special emphasis given to results achieved with razoxane. Sarcoma 2011; 2006:87367. [PMID: 17040092 PMCID: PMC1510952 DOI: 10.1155/srcm/2006/87367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose. Relatively few results are available in the
literature about the radiation response of unresectable sarcomas
in relation to their histology. Therefore, an attempt was made to
summarize the present situation. Materials and methods.
This report is based on a review of the literature and the
author's own experience. Adult-type soft tissue sarcomas,
chondrosarcomas, and chordomas were analyzed. Radioresponse was
mainly associated with the degree of tumor shrinkage, that is,
objective responses. Histopathologic responses, that is, the degree of
necrosis, are only discussed in relation to radiation treatment
reports of soft tissue sarcomas as a group. Results.
Radiation therapy alone leads to major responses in about 50% of
lipo-, fibro-, leiomyo-, or chondrosarcomas. The response rate is
less than 50% in malignant fibrous histiocytomas, synovial,
neurogenic, and other rare soft tissue sarcomas. The response
rates may increase up to 75% through the addition of
radiosensitizers such as halogenated pyrimidines or razoxane, or
by the use of high-LET irradiation. Angiosarcomas become clearly
more responsive if biologicals, angiomodulating, and/or tubulin
affinic substances are given together with radiation therapy.
Razoxane is able to increase the duration and quality of responses
even in difficult-to-treat tumors like chondrosarcomas or
chordomas. Conclusions. The available data demonstrate
that the radioresponsiveness of sarcomas is very variable and
dependent on histology, kind of radiation, and various
concomitantly given drugs. The rate of complete sustained
remissions by radiation therapy alone or in combination with drugs
is still far from satisfactory although progress has been made
through the use of sensitizing agents.
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Affiliation(s)
- Walter Rhomberg
- Department of Radiooncology, General Hospital, Carinagasse 47,
6800 Feldkirch, Austria
- *Walter Rhomberg:
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Potluri S, Jefferies S, Jena R, Harris F, Burton K, Prevost A, Burnet N. Residual Postoperative Tumour Volume Predicts Outcome after High-dose Radiotherapy for Chordoma and Chondrosarcoma of the Skull Base and Spine. Clin Oncol (R Coll Radiol) 2011; 23:199-208. [DOI: 10.1016/j.clon.2010.09.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/06/2010] [Accepted: 09/28/2010] [Indexed: 11/27/2022]
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A systematic review of proton therapy in the treatment of chondrosarcoma of the skull base. Neurosurg Rev 2010; 33:155-65. [PMID: 19921291 DOI: 10.1007/s10143-009-0235-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 09/14/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
Abstract
Chondrosarcoma (CSA) of the skull base (SB) is an uncommon, slowly growing, neoplasm comprising approximately 0.1% of all intracranial tumors and 6% of SB lesions. Even though its growth is slow, CSA is a potentially lethal tumor. The therapeutic approach to CSA of the SB is still controversial and clinical experience is limited because of the relative rarity of this tumor. The use of proton therapy (PT) after maximal surgery is widely accepted, but there are no controlled studies demonstrating the need of PT and its superiority in comparison to radiotherapy with photons. We conducted a systematic review of the scientific literature published during the period between January 1980 and June 2008 on data regarding irradiation of CSA of the SB with PT and a series of inclusion criteria. During August 2008, two independent reviewers (M.A. and D.A.), by applying the key words "skull base", "chondrosarcoma", and "proton therapy" selected those studies from the PubMed database in which a minimum of ten patients received palliative, radical, or postoperative irradiation with protons and which furnished a minimum of 24 months of follow-up. Forty nine reports were retrieved. There were no prospective trials (randomized or nonrandomized) but just nine uncontrolled single-arm studies for PT mainly related to advanced and frequently incompletely resected tumors. According to the inclusion criteria, only four articles, reporting the most recent updated results of the publishing institution, were included in the analysis providing clinical outcomes for 254 patients in total. Therapeutic approach to CSA of the SB has traditionally relied on surgical control. Radiation therapy has demonstrated to be a valuable modality for local control in the postoperative setting or in advanced/inoperable cases treated with definitive intent. The use of PT following maximal surgical resection shows a very high probability of medium- and long-term cure with a relatively low risk of significant complications.
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Obeso S, Llorente JL, Díaz-Molina JP, Sánchez-Fernández R, Rodrigo JP, Suárez C. [Surgical treatment of head and neck chondrosarcomas]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:262-71. [PMID: 20096816 DOI: 10.1016/j.otorri.2009.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 12/01/2009] [Accepted: 12/03/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Head and neck chondrosarcomas may adopt different locations and biological behaviour. MATERIAL AND METHOD We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006. RESULTS Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach. CONCLUSION Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment.
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Affiliation(s)
- Sergio Obeso
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, España
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Obeso S, Llorente JL, Pablo Díaz-Molina J, Sánchez-Fernández R, Pablo Rodrigo J, Suárez C. Surgical treatment of head and neck chondrosarcomas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Long-term control of clival chordoma with initial aggressive surgical resection and gamma knife radiosurgery for recurrence. Acta Neurochir (Wien) 2010; 152:57-67; discussion 67. [PMID: 19826755 DOI: 10.1007/s00701-009-0535-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Chordomas are locally destructive tumors with high rates of recurrence, and therapeutic strategies remain controversial. This study analyzed long-term outcomes for clival chordomas after initial aggressive surgical resection and gamma knife radiosurgery for recurrence and investigated clinical factors predicting recurrence. METHODS Clinical records were reviewed for 19 consecutive patients (11 men, 8 women; mean age, 43.1 years) with clival chordoma who underwent initial surgical resection using skull base approaches (mean follow-up after surgical resection, 87.2 months). All tumors were aggressively removed, along with the surrounding bone. Four patients were treated with radiotherapy after surgical resection.Recurrent lesions were treated with gamma knife radio surgery or reoperation. Factors predicting tumor recurrence were analyzed, including age, tumor extension, extent of resection and MIB-1 labeling index. Patient status was evaluated using the Karnofsky performance scale (KPS). RESULTS Tumor resection was total, subtotal and partial in 14, 4 and 1 patients, respectively. Tumors recurred in 11 patients. Overall, 2- and 5-year progression-free survival rates were 77.9% and 47.9%, respectively. The MIB-1 labeling index was independently associated with recurrence.The optimum cutoff point for the MIB-1 labeling index was 3.44%. All recurrent tumors were totally resected or controlled by gamma knife (mean follow-up after recurrence, 71.2 months). All patients survived and were active (mean KPS at final follow-up, 89.5%). CONCLUSION Long-term control of clival chordomas was achieved. Recurrent tumors were controlled with gamma knife radiosurgery, since lesions were localized and small after initial aggressive resection. The MIB-1 labeling index can provide important information for predicting tumor recurrence.
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Ranger A, Szymczak A. DO INTRACRANIAL NEOPLASMS DIFFER IN OLLIER DISEASE AND MAFFUCCI SYNDROME? AN IN-DEPTH ANALYSIS OF THE LITERATURE. Neurosurgery 2009; 65:1106-13; discussion 1113-5. [DOI: 10.1227/01.neu.0000356984.92242.d5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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A systematic review of intracranial chondrosarcoma and survival. J Clin Neurosci 2009; 16:1547-51. [PMID: 19796952 DOI: 10.1016/j.jocn.2009.05.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 05/02/2009] [Accepted: 05/06/2009] [Indexed: 11/20/2022]
Abstract
Most data regarding survival in patients with chondrosarcoma are limited to case studies and small series performed at single institutions. A systematic review was performed to study the relationship between potential prognostic factors and survival. The survival rates were analyzed according to modality of treatment, treatment history, histological subtype, and histological grade. A total of 560 patients with intracranial chondrosarcoma were analyzed. Median follow-up time was 60 months. The 5-year mortality among all patients was 11.5% with median survival of 24 months. Mortality at 5 years was significantly greater for patients with tumors of higher grade, or of the mesenchymal subtype, or who had received surgical resection alone. The results of our systematic review provide useful data in predicting survival among intracranial chondrosarcoma patients.
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45
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Seizeur R, Forlodou P, Quintin-Roue I, Person H, Besson G. [Chondrosarcomas of skull base treatment]. Rev Neurol (Paris) 2009; 166:305-13. [PMID: 19592057 DOI: 10.1016/j.neurol.2009.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 05/12/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Skull base chondrosarcomas are rare. Gross total removal is the treatment of choice, but can be difficult depending on the closeness of noble structures. Proton beam therapy can be associated in most cases. METHODS Retrospective study of five cases treated in 13 years and study of the literature. RESULTS Median age of patients was 34 years [28-46]. Cranial nerve palsy was the common clinical presentation. Tumor location was variable but always off midline. Treatment was surgical in all patients with a maximal resection and proton beam therapy associated for two cases. Surgical complications were rare with cranial nerve palsy as the main side effect. Outcomes were good with a median follow-up of 12.4 years [4.3-16.2]. DISCUSSION The review of the literature showed that chondrosarcomas of skull base are rare. The best outcome is achieved with total surgical resection. Medical imaging can only give clues to the diagnosis. Pathology is required to obtain a precise immunohistochemistry diagnosis. Multidisciplinary treatment using proton beam therapy and surgical removal enables a good local control (90-100%) at 5 years with good quality-of-life. It is difficult to determine how many cases have been published (around 220 cases in the literature) since many surgical or radiotherapy series included the same patients.
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Affiliation(s)
- R Seizeur
- Service de neurochirurgie, pôle neurolocomoteur, hôpital Cavale-Blanche, CHU de Brest, avenue Foch, 29609 Brest cedex, France.
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46
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Carrabba G, Dehdashti AR, Gentili F. Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach. Neurosurg Focus 2009; 25:E7. [PMID: 19035704 DOI: 10.3171/foc.2008.25.12.e7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Clival lesions pose significant challenges with regard to their surgical management. The expanded endoscopic endonasal (EEE) approach is a promising minimally invasive technique for lesions of the central skull base. The authors' aim in the current paper was to discuss the surgical treatment of clival lesions and to present the technical details, indications, and limitations of the EEE approach. Data from a recent endoscopically treated group will be compared with findings in a previous cohort of patients treated via classic open anterior and lateral approaches. METHODS Since June 2005, 17 patients with clival lesions underwent surgery via the EEE approach. Suitable candidates were chosen according to lesion characteristics, clinical parameters, and surgical goals. Neurological outcomes, Karnofsky Performance Scale scores, the extent of lesion resection, and complications were evaluated among these patients. Eighteen percent of the patients in the endoscopic group presented with recurrent disease. Another series of 43 patients, who had undergone resection of clival lesions via an anterior (rhinotomy, maxillectomy, microscopic transsphenoidal surgery, or transoral surgery) or lateral (pterional, frontoorbitozygomatic, or combined suprainfratentorial retrosigmoid) approach, was similarly reviewed. Twenty-three of these patients (53%) presented with recurrent disease and thus had undergone prior surgery. RESULTS Following the EEE approach, 11 (79%) of 14 patients who had presented with neurological symptoms experienced improvement, and gross-total resection was achieved in 59% of the patients and subtotal removal in 41%. Complications included CSF leakage (24%), tension pneumocephalus (6%), and intracranial hematoma (6%). The patient with the latter complication was the only one who experienced permanent neurological worsening. In the open resection group, neurological worsening occurred in 33% of the patients (14 of 43). Total and grosstotal removals were achieved in 84% of patients and subtotal removal in 14%. CONCLUSIONS The EEE approach has been shown to be a safe and effective technique for the resection of clival lesions with limited lateral extension. The choice of surgical approach must be tailored according to both patient and tumor characteristics. Although the 2 patient series featured in this paper are not comparable-because of a selection bias-higher rates of neurological morbidity and total and gross-total resections were observed in the open resection group. Given the long survival of some patients, the EEE approach should be favored whenever reasonable.
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Affiliation(s)
- Giorgio Carrabba
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada.
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Henderson FC, McCool K, Seigle J, Jean W, Harter W, Gagnon GJ. Treatment of chordomas with CyberKnife: georgetown university experience and treatment recommendations. Neurosurgery 2009; 64:A44-53. [PMID: 19165073 DOI: 10.1227/01.neu.0000341166.09107.47] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the efficacy and safety of chordoma treatment with CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (CK/SRS). METHODS Eighteen patients with chordoma were treated with CK/SRS as a primary adjuvant (17 patients) or the only treatment (1 patient). The series included 24 lesions (28 treatments). The median age of the patients was 60 years (range, 24-85 years). Forty-four percent of the tumors were located in the mobile spine, 39% inside the cranium, and 17% in the sacral region. The male-to-female ratio was 1:1. The mean tumor volume was 128.0 mL (range, 12.0-457.3 mL), and the median dose of 35 Gy (range, 24.0-40.0 Gy) was delivered in 5 sessions. The median follow-up period was 46 months (range, 7-65 months). RESULTS There were 3 significant complications in patients with previous irradiation, including infection in the surgical/radiation site (2 patients) and decreased vision (1 patient). Improvement in pain and quality of life did not reach statistical significance (alpha = 0.05). Seven patients experienced recurrence at a median of 10 months (range, 5-38 months), and 4 patients with disseminated disease died 7 to 48 months after therapy. Two patients had a partial response, whereas 9 others had stable disease. The local control rate at 65 months was 59.1%, with an overall survival of 74.3% and disease-specific survival of 88.9%. We estimated an alpha/beta ratio of 2.45 for chordomas, which supports hypofractionation. CONCLUSION The CK/SRS safety and efficacy profile compares favorably with those of other treatment delivery systems. CK/SRS appears to reduce tumor volume, given an adequate dose. The authors recommend treatment with 40 Gy in 5 sessions to the clinical treatment volume, which includes the gross tumor volume and at least a 1-cm margin.
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Affiliation(s)
- Fraser C Henderson
- Department of Radiology, Georgetown University, Washington, District of Columbia 20007, USA.
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Seizeur R, Forlodou P, Quintin-Roue I, Person H, Besson G. Chondrosarcoma of the skull base in Maffucci's syndrome. Br J Neurosurg 2009; 22:778-80. [PMID: 19085363 DOI: 10.1080/02688690802056575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report a new case of skull base chondrosarcoma in Maffucci's syndrome. Maffucci's syndrome combining enchondromatosis with cutaneous haemangioma is rarely associated with chondrosarcoma. The review of literature highlights a small number of this pathological association.
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Affiliation(s)
- R Seizeur
- Service de Neurochirurgie, CHU Cavale Blanche, Brest, France
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Kathiravel Y, Finnis NDM. Primary falcine chondrosarcoma. J Clin Neurosci 2008; 15:1406-9. [PMID: 18842412 DOI: 10.1016/j.jocn.2007.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Revised: 07/31/2007] [Accepted: 08/09/2007] [Indexed: 10/21/2022]
Abstract
Non-skull-base intracranial chondrosarcomas are extremely rare. We present a patient with a classic falcine chondrosarcoma and review the radiological features that may aid in a pre-operative diagnosis, as well as the adjuvant treatment options. A 32-year-old woman presented with a 5-year history of progressive weakness in her right leg. MRI scan demonstrated a 4.9 x 4.3 x 2.7 cm irregular parasaggital mass in the left frontoparietal region that was in contact with the falx. A left fronto-parietal craniotomy was performed and gross total excision was achieved. Intracranial chondrosarcomas that occur above the skull base tend to be of the mesenchymal variety. Classic chondrosarcomas of the falx are rare. The management of these tumours is surgery, with adjuvant radiotherapy for incompletely excised lesions.
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Affiliation(s)
- Y Kathiravel
- Department of Neurosurgery, Christchurch Hospital, Private Bag 4710, Christchurch 8001, New Zealand
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Surgical treatment of skull base chondrosarcomas. Neurosurg Rev 2008; 32:67-75; discussion 75. [DOI: 10.1007/s10143-008-0170-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 08/17/2008] [Accepted: 08/17/2008] [Indexed: 10/21/2022]
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