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J Neurol Surg B Skull Base 2021; 82(02): 161-174
DOI: 10.1055/s-0039-3402019
Original Article

Use of Salvage Surgery or Stereotactic Radiosurgery for Multiply Recurrent Skull Base Chordomas: A Single-Institution Experience and Review of the Literature

Stella K. Yoo
1   Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Ben A. Strickland
2   Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Gabriel Zada
2   Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Shelly X. Bian
1   Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Adam Garsa
1   Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Jason C. Ye
1   Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Cheng Yu
2   Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Martin H. Weiss
2   Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Bozena B. Wrobel
3   Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California, United States
,
Steven Giannotta
2   Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
,
Eric L. Chang
1   Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
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Abstract

Introduction Chordomas are locally destructive neoplasms characterized by appreciable recurrence rates after initial multimodality treatment. We examined the outcome of salvage treatment in recurrent/progressive skull base chordomas.

Methods This is a retrospective review of recurrent/progressive skull base chordomas at a tertiary urban academic medical center. The outcomes evaluated were overall survival, progression-free survival (PFS), and incidence of new toxicity.

Results Eighteen consecutive patients who underwent ≥1 course of treatment (35.3% salvage surgery, 23.5% salvage radiation, and 41.2% both) were included. The median follow-up was 98.6 months (range 16–215 months). After initial treatment, the median PFS was 17.7 months (95% confidence interval [CI]: 4.9–22.6 months). Following initial therapy, age ≥ 40 had improved PFS on univariate analysis (p = 0.03). All patients had local recurrence, with 15 undergoing salvage surgical resections and 16 undergoing salvage radiation treatments (mostly stereotactic radiosurgery [SRS]). The median PFS was 59.2 months (95% CI: 4.0–99.3 months) after salvage surgery, 58.4 months (95% CI: 25.9–195 months) after salvage radiation, and 58.4 months (95% CI: 25.9.0–98.4 months) combined. Overall survival for the total cohort was 98.7% ± 1.7% at 2 years and 92.8% ± 5.5% at 5 years. Salvage treatments were well-tolerated with two patients (11%) reporting tinnitus and one patient each (6%) reporting headaches, visual field deficits, hearing loss, anosmia, dysphagia, or memory loss.

Conclusion Refractory skull base chordomas present a challenging treatment dilemma. Repeat surgical resection or SRS seems to provide adequate salvage therapy that is well-tolerated when treated at a tertiary center offering multimodality care.

Keywords

chordoma - skull base - radiation therapy - surgery - recurrence - Gamma Knife


Publication History

Received: 24 June 2019

Accepted: 09 November 2019

Article published online:
14 January 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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