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J Neurol Surg B Skull Base 2021; 82(S 03): e155-e165
DOI: 10.1055/s-0040-1701523
Original Article

Management of Recurrent or Progressing Skull Base Chondrosarcomas: Predictors of Long-Term Outcomes

Jonathan D. Breshears
1   Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Franco DeMonte
1   Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Ahmed Habib
1   Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Paul W. Gidley
2   Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Shaan M. Raza
1   Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
› Author Affiliations Funding None.
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Abstract

Background Skull base chondrosarcomas (CSA) are difficult tumors to cure and there is little data regarding salvage therapy.

Objective This study aims to identify presentation and treatment-related factors which impact the progression free survival (PFS) and disease specific survival (DSS) for recurrent CSA, and to identify salvage treatment factors associated with successful restoration to the natural history following primary treatment.

Methods This single-institution retrospective review included patients with recurrent/progressive CSA over a 25-year period. Survival analysis for factors impacting PFS and DSS was performed. Salvage treatment factors associated with achieving PFS ≥newly diagnosed median PFS were identified using univariate statistics. Analysis was performed on first recurrences and all recurrences combined.

Results A total of 47 recurrence/progression events were analyzed from 17 patients (median two events/patient, range = 1–8). The overall PFS and DSS for the initial recurrence was 32 (range = 3–267) and 79 (range = 3–285) months, respectively. Conventional grade III or mesenchymal histology significantly predicted shorter PFS and DSS (p < 0.0001). After stratification by histology, previous radiation predicted shorter PFS for low-grade tumors (p = 0.009). Gross total resection (GTR) after a first time recurrence was significantly associated with successful salvage treatment (p < 0.05); however, this was rare.

Conclusion In this series, high grade histology and prior radiation treatment negatively impacted salvage treatment outcomes, while GTR was associated with restoration to natural history following primary treatment. Careful consideration of histology, systemic disease status, previous treatments, and the anatomic extent of the skull base disease can optimize the outcomes of salvage intervention.

Keywords

skull base chondrosarcoma - recurrence - progression - salvage surgery

Note

The portions of this work was presented at the 2019 Annual Meeting of the North American Skull Base Society. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.




Publication History

Received: 20 August 2019

Accepted: 02 December 2019

Article published online:
07 February 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Berkmen YM, Blatt ES. Cranial and intracranial cartilaginous tumours. Clin Radiol 1968; 19 (03) 327-333
    CrossrefPubMedGoogle Scholar
  • 2 Heffelfinger MJ, Dahlin DC, MacCarty CS, Beabout JW. Chordomas and cartilaginous tumors at the skull base. Cancer 1973; 32 (02) 410-420
    CrossrefPubMedGoogle Scholar
  • 3 Rosenberg AE, Nielsen GP, Keel SB. et al. Chondrosarcoma of the base of the skull: a clinicopathologic study of 200 cases with emphasis on its distinction from chordoma. Am J Surg Pathol 1999; 23 (11) 1370-1378
    CrossrefPubMedGoogle Scholar
  • 4 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 (03) 520-530
    CrossrefPubMedGoogle Scholar
  • 5 Bloch OG, Jian BJ, Yang I. et al. A systematic review of intracranial chondrosarcoma and survival. J Clin Neurosci 2009; 16 (12) 1547-1551
    CrossrefPubMedGoogle Scholar
  • 6 Samii A, Gerganov V, Herold C, Gharabaghi A, Hayashi N, Samii M. Surgical treatment of skull base chondrosarcomas. Neurosurg Rev 2009; 32 (01) 67-75
    CrossrefPubMedGoogle Scholar
  • 7 Tzortzidis F, Elahi F, Wright DC, Temkin N, Natarajan SK, Sekhar LN. Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chondrosarcomas. Neurosurgery 2006; 58 (06) 1090-1098
    CrossrefPubMedGoogle Scholar
  • 8 Wanebo JE, Bristol RE, Porter RR, Coons SW, Spetzler RF. Management of cranial base chondrosarcomas. Neurosurgery 2006; 58 (02) 249-255
    CrossrefPubMedGoogle Scholar
  • 9 Biermann JS, Chow W, Reed DR. et al. NCCN guidelines insights: bone cancer, version 2.2017. J Natl Compr Canc Netw 2017; 15 (02) 155-167
    CrossrefPubMedGoogle Scholar
  • 10 Bloch OG, Jian BJ, Yang I. et al. Cranial chondrosarcoma and recurrence. Skull Base 2010; 20 (03) 149-156
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Isaacson B, Kutz JW, Roland PS. Lesions of the petrous apex: diagnosis and management. Otolaryngol Clin North Am 2007; 40 (03) 479-519 , viii
    CrossrefPubMedGoogle Scholar
  • 12 Koga T, Shin M, Saito N. Treatment with high marginal dose is mandatory to achieve long-term control of skull base chordomas and chondrosarcomas by means of stereotactic radiosurgery. J Neurooncol 2010; 98 (02) 233-238
    CrossrefPubMedGoogle Scholar
  • 13 Neff B, Sataloff RT, Storey L, Hawkshaw M, Spiegel JR. Chondrosarcoma of the skull base. Laryngoscope 2002; 112 (01) 134-139
    CrossrefPubMedGoogle Scholar
  • 14 La Rocca RV, Morgan KW, Paris K, Baeker TR. Recurrent chondrosarcoma of the cranial base: a durable response to ifosfamide-doxorubicin chemotherapy. J Neurooncol 1999; 41 (03) 281-283
    CrossrefPubMedGoogle Scholar
  • 15 Murakami Y, Jinguji S, Kishida Y. et al. Multiple surgical treatments for repeated recurrence of skull base mesenchymal chondrosarcoma. NMC Case Rep J 2018; 5 (04) 99-103
    CrossrefPubMedGoogle Scholar
  • 16 Raza SM, Bell D, Freeman JL, Grosshans DR, Fuller GN, DeMonte F. Multimodality management of recurrent skull base chordomas: factors impacting tumor control and disease-specific survival. Oper Neurosurg (Hagerstown) 2018; 15 (02) 131-143
    CrossrefPubMedGoogle Scholar
  • 17 Dahlin DC, Beabout JW. Dedifferentiation of low-grade chondrosarcomas. Cancer 1971; 28 (02) 461-466
    CrossrefPubMedGoogle Scholar
  • 18 Austin JP, Urie MM, Cardenosa G, Munzenrider JE. Probable causes of recurrence in patients with chordoma and chondrosarcoma of the base of skull and cervical spine. Int J Radiat Oncol Biol Phys 1993; 25 (03) 439-444
    CrossrefPubMedGoogle Scholar
  • 19 Ng S-H, Liu H-M, Ko S-F, Hao S-P, Chong VF. Posttreatment imaging of the nasopharynx. Eur J Radiol 2002; 44 (02) 82-95
    CrossrefPubMedGoogle Scholar
  • 20 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) 2018; 14 (06) 611-619
    CrossrefPubMedGoogle Scholar
  • 21 Markiewicz MR, Pirgousis P, Bryant C. et al. Preoperative protective endovascular covered stent placement followed by surgery for management of the cervical common and internal carotid arteries with tumor encasement. J Neurol Surg B Skull Base 2017; 78 (01) 52-58
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Nussbaum ES, Levine SC, Hamlar D, Madison MT. Carotid stenting and “extarterectomy” in the management of head and neck cancer involving the internal carotid artery: technical case report. Neurosurgery 2000; 47 (04) 981-984
    CrossrefPubMedGoogle Scholar
  • 23 Piazza P, Di Lella F, Bacciu A, Di Trapani G, Ait Mimoune H, Sanna M. Preoperative protective stenting of the internal carotid artery in the management of complex head and neck paragangliomas: long-term results. Audiol Neurotol 2013; 18 (06) 345-352
    CrossrefPubMedGoogle Scholar
  • 24 Teknos TN, Smith JC, Day TA, Netterville JL, Burkey BB. Microvascular free tissue transfer in reconstructing skull base defects: lessons learned. Laryngoscope 2002; 112 (10) 1871-1876
    CrossrefPubMedGoogle Scholar
  • 25 Disa JJ, Rodriguez VM, Cordeiro PG. Reconstruction of lateral skull base oncological defects: the role of free tissue transfer. Ann Plast Surg 1998; 41 (06) 633-639
    CrossrefPubMedGoogle Scholar
  • 26 Hanasono MM, Sacks JM, Goel N, Ayad M, Skoracki RJ. The anterolateral thigh free flap for skull base reconstruction. Otolaryngol Head Neck Surg 2009; 140 (06) 855-860
    CrossrefPubMedGoogle Scholar
  • 27 Price JC, Loury M, Carson B, Johns ME. The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope 1988; 98 (11) 1159-1164
    CrossrefPubMedGoogle Scholar