TY - JOUR
T1 - Current surgical outcomes for cranial base chordomas
T2 - Cohort study of 95 patients
AU - Di Maio, Salvatore
AU - Rostomily, Robert C.
AU - Sekhar, Laligam N.
PY - 2012/6/1
Y1 - 2012/6/1
N2 - Background: Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. Objective: To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. Methods: From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. Results: Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). Conclusion: Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS.
AB - Background: Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. Objective: To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. Methods: From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. Results: Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). Conclusion: Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS.
KW - Chordoma
KW - Microsurgery
KW - Neurosurgery
KW - Skull base neoplasms
KW - Skull base surgery
KW - Surgical outcomes
UR - http://www.scopus.com/inward/record.url?scp=84861530823&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84861530823&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e3182446783
DO - 10.1227/NEU.0b013e3182446783
M3 - Article
C2 - 22157545
AN - SCOPUS:84861530823
VL - 70
SP - 1355
EP - 1360
JO - Neurosurgery.
JF - Neurosurgery.
SN - 0148-396X
IS - 6
ER -