Proposed Treatment Paradigm for Intracranial Chondrosarcomas Based on Multidisciplinary Coordination

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 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 administrated 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 prior 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). Stereotactic radiosurgery subgroup presented best 5-year PFS of 88.9%, and linear accelerator prolonged the mean PFS time (57.0 months) than no radiation (38.1 months). In incomplete resection subgroup (n = 63), radiotherapy significantly benefited to tumor control (HR: 2.101, p = 0.016). Extent of surgical resection (HR: 1.797, p = 0.026) and malignant pathology (HR: 1.717, p = 0.030) were associated with OS.

At recent follow-up, 35 patients (34.3%) were alive without evidence of disease, 25 patients (24.5%) were alive with stable disease (unchanged residual); however, 17 patients (16.7%) were alive with progressive disease and 23 patients (22.5%) died of the disease. The mean and median follow-up KPS scores were 64.7 and 80, respectively, which was worse than preoperative KPS (z = −2.599, p = 0.009) but comparative to KPS at discharge (z = −1.094, p = 0.274). If excluding deaths, the mean KPS in 77 survivors was 85.7 that was significantly better than preoperative KPS (mean: 81.7, z = −3.152, p = 0.002) and KPS at discharge (mean: 77.7, z = −5.288, p < 0.001), and the statistical results showed improved quality of life by surgery and recovery of surgical morbidity during follow-up if absence of death due to the disease.

Conclusion Intracranial CSAs were not completely amendable by surgery alone. GTR as far as possible plus radiation was necessary for mesenchymal CSA and conventional CSA with active growth. Stereotactic radiosurgery was alternative if the proton therapy was unavailable. Future study based on large cohort was required to verify the validity of our results.