Clival chordoma: a single-centre outcome analysis
Autor: | Doron Merkler, Max Jägersberg, Philipp Dammann, Amir El Rahal, Karl Lothard Schaller, Damien C. Weber |
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Jazyk: | angličtina |
Rok vydání: | 2017 |
Předmět: |
musculoskeletal diseases
Adult Male medicine.medical_specialty medicine.medical_treatment Population Medizin Antineoplastic Agents 610 Medicine & health ddc:616.07 Radiosurgery Skull Base Neoplasms Disease-Free Survival Neurosurgical Procedures Pazopanib 03 medical and health sciences 0302 clinical medicine medicine Chordoma Humans education Survival rate Aged Retrospective Studies education.field_of_study medicine.diagnostic_test business.industry Retrospective cohort study Interventional radiology Middle Aged medicine.disease Combined Modality Therapy ddc:616.8 Surgery Radiation therapy Survival Rate Treatment Outcome Cranial Fossa Posterior 030220 oncology & carcinogenesis Female Neurology (clinical) Neurosurgery business 030217 neurology & neurosurgery medicine.drug |
Zdroj: | Jägersberg, Max; El Rahal, Amir; Dammann, Philipp; Merkler, Doron; Weber, Damien Charles; Schaller, Karl (2017). Clival chordoma: a single-centre outcome analysis. Acta neurochirurgica, 159(10), pp. 1815-1823. Springer 10.1007/s00701-017-3163-7 Acta Neurochirurgica, Vol. 159, No 10 (2017) pp. 1815-1823 |
ISSN: | 0001-6268 |
Popis: | BACKGROUND The treatment of clival chordomas remains challenging. Total tumour resection is often impossible without hampering adjacent anatomical structures and causing functional sequelae. On the other hand, chordomas show limited response to non-surgical treatment modalities. Up to now, no well-established interdisciplinary treatment algorithms for clival chordomas exist. In this regard, we analysed the data from all patients that underwent interdisciplinary treatment for clival chordoma in our institution over the last 10 years. METHOD Retrospective report of all patients treated at the authors' institution from 2005 to 2015. RESULTS Thirteen patients underwent 24 surgeries, of which 2 (8%) were gross total resections and 22 (92%) incomplete resections. Neurological deterioration, endocrinological disturbances and other surgical complications were observed in six (25%), three (13%) and nine (38%) cases, respectively. Three surgeries (13%) led to an improvement of the initial preoperative neurological condition. All patients were discussed on the interdisciplinary tumour board and all underwent one type of radiotherapy following initial surgery: proton beam in 11 cases (85%) and photon beam in two (15%) cases. In the course of their recurrent disease, three patients (23%) received systemic therapy (imatinib, pazopanib and nivolumab). One patient received a personalised cellular immunotherapy. One patient (8%) was lost to follow-up. Of the remaining 12 patients, four patients (33%) died in the period of analysis; all deaths were chordoma-related. The 5-year cumulative survival rate was 83% (52-97%, CI 95%), 5-year progression-free survival rate was 53% (26-79%, CI 95%). The eight patients (66%) still alive had favourable outcome (KPS, 90 ± 10.7%). SF36 analysis among the survivors revealed 43 points for the Physical Component Summary (12% above, 38% at and 50% below the general population norm) and 47 points for the Mental Component Summary (25% above, 38% at and 38% below). CONCLUSIONS Our patients show a low rate of gross total resection but an outcome well comparable to other published results. This emphasises the importance of interdispiplinary treatment strategies, with surgery supplying maximal safe resection and avoiding severe neurological deficit, allowing patients to undergo adjusted radiotherapy and other treatment options in a good condition. |
Databáze: | OpenAIRE |
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