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Long-term outcomes of grade I/II skull base chondrosarcoma: an insight into the role of surgery and upfront radiotherapy

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Abstract

Purpose

To clarify the need for post-operative radiation treatment in skull base chondrosarcomas (SBCs).

Methods

A retrospective analysis of patients with grade I or II SBC. Patients were divided according to post-surgical treatment strategies: (A) planned upfront radiotherapy and (B) watchful waiting. Tumor control and survival were compared between the treatment groups. The median follow-up after resection was 105 months (range, 9–376).

Results

Thirty-two patients (Grade 1, n = 16; Grade 2, n = 16) were included. The most frequent location was petroclival (21, 64%). A gross total resection (GTR) was achieved in 11 patients (34%). Fourteen (44%) underwent upfront radiotherapy (group A) whereas 18 (56%) were followed with serial MRI alone (group B). The tumor control rate for the entire group was 77% and 69% at 10- and 15-year, respectively. Upfront radiotherapy (P = 0.25), extent of resection (P = 0.11) or tumor grade (P = 0.83) did not affect tumor control. The majority of Group B patients with recurrent tumors (5/7) obtained tumor control with repeat resection (n = 2), salvage radiotherapy (n = 2), or a combination of both (n = 1). The 10-year disease-specific survival was 95% with no difference between the group A and B (P = 0.50).

Conclusion

For patients with grade I/II SBC, a reasonable strategy is deferral of radiotherapy after maximum safe resection until tumor progression or recurrence. At that time, most patients can be successfully managed with salvage radiotherapy or surgery. Late recurrences may occur, and life-long follow-up is advisable.

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Data Availability

The data will be available upon reasonable request to the corresponding author.

References

  1. Evans HL, Ayala AG, Romsdahl MM (1977) Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer 40(2):818–831

    Article  CAS  PubMed  Google Scholar 

  2. Weber AL, Brown EW, Hug EB, Liebsch NJ (1995) Cartilaginous tumors and chordomas of the cranial base. Otolaryngol Clin North Am 28(3):453–471

    Article  CAS  PubMed  Google Scholar 

  3. Awad M, Gogos AJ, Kaye AH (2016) Skull base chondrosarcoma. J Clin Neurosci 24:1–5. https://doi.org/10.1016/j.jocn.2015.10.029

    Article  PubMed  Google Scholar 

  4. Bloch OG, Jian BJ, Yang I, Han SJ, Aranda D, Ahn BJ, Parsa AT (2009) A systematic review of intracranial chondrosarcoma and survival. J Clin Neurosci 16(12):1547–1551. https://doi.org/10.1016/j.jocn.2009.05.003

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mokhtari S, Mirafsharieh A (2012) Clear cell chondrosarcoma of the head and neck. Head Neck Oncol 4:13. https://doi.org/10.1186/1758-3284-4-13

    Article  PubMed  PubMed Central  Google Scholar 

  6. Nakashima Y, Unni KK, Shives TC, Swee RG, Dahlin DC (1986) Mesenchymal chondrosarcoma of bone and soft tissue. A review of 111 cases. Cancer 57(12):2444–2453

    Article  CAS  PubMed  Google Scholar 

  7. Ma XJ, Meng GL, Wang K, Li D, Wang L, Li H, Zhang JT, Zhang LW, Wu Z (2019) The differences between intracranial mesenchymal chondrosarcoma and conventional chondrosarcoma in clinical features and outcomes. World Neurosurg 122:E1078–E1082. https://doi.org/10.1016/j.wneu.2018.10.230

    Article  PubMed  Google Scholar 

  8. Amer KM, Munn M, Congiusta D, Abraham JA, Basu Mallick A (2020) Survival and prognosis of chondrosarcoma subtypes: SEER database analysis. J Orthop Res 38(2):311–319. https://doi.org/10.1002/jor.24463

    Article  PubMed  Google Scholar 

  9. Korten AG, ter Berg HJ, Spincemaille GH, van der Laan RT, Van de Wel AM (1998) Intracranial chondrosarcoma: review of the literature and report of 15 cases. J Neurol Neurosurg Psychiatry 65(1):88–92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Carlson ML, O’Connell BP, Breen JT, Wick CC, Driscoll CL, Haynes DS, Thompson RC, Isaacson B, Gidley PW, Kutz JW Jr, Van Gompel JJ, Wanna GB, Raza SM, DeMonte F, Barnett SL, Link MJ (2016) Petroclival chondrosarcoma: A multicenter review of 55 cases and new staging system. Otol Neurotol 37(7):940–950. https://doi.org/10.1097/MAO.0000000000001037

    Article  PubMed  Google Scholar 

  11. Gatfield ER, Noble DJ, Barnett GC, Early NY, Hoole ACF, Kirkby NF, Jefferies SJ, Burnet NG (2018) Tumour volume and dose influence outcome after surgery and high-dose photon radiotherapy for chordoma and chondrosarcoma of the skull base and spine. Clin Oncol (R Coll Radiol) 30(4):243–253. https://doi.org/10.1016/j.clon.2018.01.002

    Article  CAS  Google Scholar 

  12. Simon F, Feuvret L, Bresson D, Guichard JP, El Zein S, Bernat AL, Labidi M, Calugaru V, Froelich S, Herman P, Verillaud B (2018) Surgery and protontherapy in Grade I and II skull base chondrosarcoma: A comparative retrospective study. PLoS ONE 13(12):e0208786. https://doi.org/10.1371/journal.pone.0208786

    Article  PubMed  PubMed Central  Google Scholar 

  13. Weber DC, Badiyan S, Malyapa R, Albertini F, Bolsi A, Lomax AJ, Schneider R (2016) Long-term outcomes and prognostic factors of skull-base chondrosarcoma patients treated with pencil-beam scanning proton therapy at the Paul Scherrer Institute. Neuro Oncol 18(2):236–243. https://doi.org/10.1093/neuonc/nov154

    Article  CAS  PubMed  Google Scholar 

  14. Holtzman AL, Rotondo RL, Rutenberg MS, Indelicato DJ, Mercado CE, Rao D, Tavanaiepour D, Morris CG, Louis D, Flampouri S, Mendenhall WM (2019) Proton therapy for skull-base chondrosarcoma, a single-institution outcomes study. J Neurooncol 142(3):557–563. https://doi.org/10.1007/s11060-019-03129-8

    Article  CAS  PubMed  Google Scholar 

  15. Koga T, Shin M, Saito N (2010) 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 98(2):233–238. https://doi.org/10.1007/s11060-010-0184-y

    Article  PubMed  Google Scholar 

  16. Uhl M, Mattke M, Welzel T, Oelmann J, Habl G, Jensen AD, Ellerbrock M, Haberer T, Herfarth KK, Debus J (2014) High control rate in patients with chondrosarcoma of the skull base after carbon ion therapy: first report of long-term results. Cancer 120(10):1579–1585. https://doi.org/10.1002/cncr.28606

    Article  PubMed  Google Scholar 

  17. Amichetti M, Amelio D, Cianchetti M, Enrici RM, Minniti G (2010) A systematic review of proton therapy in the treatment of chondrosarcoma of the skull base. Neurosurg Rev 33(2):155–165. https://doi.org/10.1007/s10143-009-0234-0

    Article  PubMed  Google Scholar 

  18. Sahgal A, Chan MW, Atenafu EG, Masson-Cote L, Bahl G, Yu E, Millar BA, Chung C, Catton C, O’Sullivan B, Irish JC, Gilbert R, Zadeh G, Cusimano M, Gentili F, Laperriere NJ (2015) Image-guided, intensity-modulated radiation therapy (IG-IMRT) for skull base chordoma and chondrosarcoma: preliminary outcomes. Neuro Oncol 17(6):889–894. https://doi.org/10.1093/neuonc/nou347

    Article  CAS  PubMed  Google Scholar 

  19. Mattke M, Vogt K, Bougatf N, Welzel T, Oelmann-Avendano J, Hauswald H, Jensen A, Ellerbrock M, Jakel O, Haberer T, Herfarth K, Debus J, Uhl M (2018) High control rates of proton- and carbon-ion-beam treatment with intensity-modulated active raster scanning in 101 patients with skull base chondrosarcoma at the Heidelberg Ion Beam Therapy Center. Cancer 124(9):2036–2044. https://doi.org/10.1002/cncr.31298

    Article  CAS  PubMed  Google Scholar 

  20. Li D, Weng JC, Zhang GJ, Hao SY, Tang J, Zhang LW, Wang L, Wu Z, Jia W, Zhang JT (2018) Proposed treatment paradigm for intracranial chondrosarcomas based on multidisciplinary coordination. World Neurosurg 109:e517–e530. https://doi.org/10.1016/j.wneu.2017.10.013

    Article  PubMed  Google Scholar 

  21. Raza SM, Gidley PW, Meis JM, Grosshans DR, Bell D, DeMonte F (2017) Multimodality treatment of skull base chondrosarcomas: the role of histology specific treatment protocols. Neurosurgery 81(3):520–530. https://doi.org/10.1093/neuros/nyx042

    Article  PubMed  Google Scholar 

  22. Tzortzidis F, Elahi F, Wright DC, Temkin N, Natarajan SK, Sekhar LN (2006) Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chondrosarcomas. Neurosurgery 58(6):1090–1098; discussion 1090–1098. https://doi.org/10.1227/01.NEU.0000215892.65663.54

  23. Sbaihat A, Bacciu A, Pasanisi E, Sanna M (2013) Skull base chondrosarcomas: surgical treatment and results. Ann Otol Rhinol Laryngol 122(12):763–770

    Article  PubMed  Google Scholar 

  24. Vaz-Guimaraes F, Fernandez-Miranda JC, Koutourousiou M, Hamilton RL, Wang EW, Snyderman CH, Gardner PA (2017) Endoscopic endonasal surgery for cranial base chondrosarcomas. Oper Neurosurg (Hagerstown) 13(4):421–434. https://doi.org/10.1093/ons/opx020

    Article  Google Scholar 

  25. Hasegawa H, Shin M, Kondo K, Hanakita S, Mukasa A, Kin T, Saito N (2018) Role of endoscopic transnasal surgery for skull base chondrosarcoma: a retrospective analysis of 19 cases at a single institution. J Neurosurg 128(5):1438–1447. https://doi.org/10.3171/2017.1.JNS162000

    Article  PubMed  Google Scholar 

  26. Samii A, Gerganov V, Herold C, Gharabaghi A, Hayashi N, Samii M (2009) Surgical treatment of skull base chondrosarcomas. Neurosurg Rev 32(1):67–75; discussion 75. https://doi.org/10.1007/s10143-008-0170-4

  27. Cho YH, Kim JH, Khang SK, Lee JK, Kim CJ (2008) Chordomas and chondrosarcomas of the skull base: comparative analysis of clinical results in 30 patients. Neurosurg Rev 31(1):35–43; discussion 43. https://doi.org/10.1007/s10143-007-0099-z

  28. Almefty K, Pravdenkova S, Colli BO, Al-Mefty O, Gokden M (2007) Chordoma and chondrosarcoma: similar, but quite different, skull base tumors. Cancer 110(11):2457–2467. https://doi.org/10.1002/cncr.23073

    Article  PubMed  Google Scholar 

  29. Wanebo JE, Bristol RE, Porter RR, Coons SW, Spetzler RF (2006) Management of cranial base chondrosarcomas. Neurosurgery 58(2):249–255; discussion 249–255. https://doi.org/10.1227/01.NEU.0000194834.74873.FB

  30. Oghalai JS, Buxbaum JL, Jackler RK, McDermott MW (2005) Skull base chondrosarcoma originating from the petroclival junction. Otol Neurotol 26(5):1052–1060. https://doi.org/10.1097/01.mao.0000185076.65822.f7

    Article  PubMed  Google Scholar 

  31. Crockard HA, Cheeseman A, Steel T, Revesz T, Holton JL, Plowman N, Singh A, Crossman J (2001) A multidisciplinary team approach to skull base chondrosarcomas. J Neurosurg 95(2):184–189. https://doi.org/10.3171/jns.2001.95.2.0184

    Article  CAS  PubMed  Google Scholar 

  32. Frezza AM, Cesari M, Baumhoer D, Biau D, Bielack S, Campanacci DA, Casanova J, Esler C, Ferrari S, Funovics PT, Gerrand C, Grimer R, Gronchi A, Haffner N, Hecker-Nolting S, Holler S, Jeys L, Jutte P, Leithner A, San-Julian M, Thorkildsen J, Vincenzi B, Windhager R, Whelan J (2015) Mesenchymal chondrosarcoma: prognostic factors and outcome in 113 patients. A European Musculoskeletal Oncology Society study. Eur J Cancer 51(3):374–381. https://doi.org/10.1016/j.ejca.2014.11.007

    Article  PubMed  Google Scholar 

  33. Strotman PK, Reif TJ, Kliethermes SA, Sandhu JK, Nystrom LM (2017) Dedifferentiated chondrosarcoma: a survival analysis of 159 cases from the SEER database (2001–2011). J Surg Oncol 116(2):252–257. https://doi.org/10.1002/jso.24650

    Article  PubMed  Google Scholar 

  34. Lu VM, O’Connor KP, Mahajan A, Carlson ML, Van Gompel JJ (2020) Carbon ion radiotherapy for skull base chordomas and chondrosarcomas: a systematic review and meta-analysis of local control, survival, and toxicity outcomes. J Neurooncol 147(3):503–513. https://doi.org/10.1007/s11060-020-03464-1

    Article  CAS  PubMed  Google Scholar 

  35. Nie Z, Lu Q, Peng H (2018) Prognostic factors for patients with chondrosarcoma: A survival analysis based on the surveillance, epidemiology, and end results (SEER) database (1973–2012). J Bone Oncol 13:55–61. https://doi.org/10.1016/j.jbo.2018.09.003

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Departments of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Hirotaka Hasegawa, Kunal Vakharia, Christopher S. Graffeo, Bruce E. Pollock, Avital Perry, Jamie J. Van Gompel & Michael J. Link

  2. Departments of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA

    Matthew L. Carlson & Colin L. W. Driscoll

  3. Departments of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Paul D. Brown

  4. Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan

    Hirotaka Hasegawa

Authors
  1. Hirotaka Hasegawa
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Contributions

HH: conceptualization, data acquisition, analysis, interpretation, drafting manuscript, final approval of the version to be published. KV: data acquisition, final approval of the version to be published. CSG: conceptualization, data analysis, critically revising manuscript, final approval of the version to be published. MLC: critically revising manuscript, final approval of the version to be published. BEP: interpretation, critically revising manuscript, final approval of the version to be published. PDB: interpretation, critically revising manuscript, final approval of the version to be published. AP: conceptualization, data acquisition, final approval of the version to be published. JJVG: critically revising manuscript, final approval of the version to be published. CLWD: critically revising manuscript, final approval of the version to be published. MJL: conceptualization, interpretation, critically revising manuscript, final approval of the version to be published.

Corresponding author

Correspondence to Michael J. Link.

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The study was approved by Institutional Review board (IRB #20-002,412).

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Informed consent was waived given the retrospective non-invasive nature of the study.

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Hasegawa, H., Vakharia, K., Graffeo, C.S. et al. Long-term outcomes of grade I/II skull base chondrosarcoma: an insight into the role of surgery and upfront radiotherapy. J Neurooncol 153, 273–281 (2021). https://doi.org/10.1007/s11060-021-03764-0

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