Surgical Management of Clival Malignancies: Predictors of Quality of Life

Background: Clival tumors are difficult to treat because of nearby vital structures and cranial nerves, necessitating aggressive multimodal strategies balanced with efforts to avoid treatment-associated decline in performance.

Objective: We sought to assess factors that predict better postoperative performance in patients undergoing surgery for clival tumors.

Methods: We reviewed all medical records for patients surgically treated for clival malignancy between September 1, 1993, and July 1, 2017, at our institution. We collected patient demographics, preoperative performance, tumor characteristics, treatment modalities, pathological data, and postoperative performance data to evaluate 108 patients. Postoperative performance scores were collected at 6 and 12 months after surgery.

Results: The 5-year survival rate was 67.7%. The 5-year progression-free survival rate was 51.8%. Average Karnofsky Performance Status (KPS) scores were 89.5 (median 90) at the preoperative visit, 88.5 (90) at 6 months postoperation, and 87.1 (90) at 12 months postoperation. We found that a higher preoperative KPS (n = 108; p < 0.001), and staged surgery (n = 87; p = 0.0051) were predictors of a higher postoperative KPS score at 12 months postoperation. In addition, we found that osteosarcoma diagnosis (n = 11; p = 0.01), prior medical treatment (n = 31; p = 0.0347), prior radiation treatment (n = 21; p = 0.014), prior chemotherapy treatment (n = 8; p < 0.0001), free flap reconstruction (n = 13; p = 0.03), staged surgical approach (n = 87; p = 0.0051), pterygoid plate involvement (n = 33; p = 0.0299), ethmoid sinus involvement (n = 22; p = 0.0125), maxillary sinus involvement (n = 12; p < 0.0001), orbit involvement (n = 12; p < 0.0001), infratemporal fossa involvement (n = 23; p = 0.0017), pterygopalatine fossa involvement (n = 24; p = 0.0051), temporal bone involvement (n = 56; p = 0.0205), and brain invasion (n = 15; p = 0.0403) were predictors of a lower postoperative KPS score at 12 months postoperation.

Conclusion: Higher preoperative KPS score and a staged surgical approach were the best predictors of a higher postoperative KPS score. This work provides treatment teams and patients with better information on outcomes for shared decision making.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021