Abstract
Clival chordoma is a rare disease with high recurrence rates even after a combination of surgical resection and radiotherapy. Apparent diffusion coefficient (ADC) has been used to evaluate aggressive features of chordoma, but its utility for clival chordoma has not been explored specifically. In this study, the utility of preoperative ADC values was analyzed for predicting tumor progression and recurrence in patients with clival chordoma. Between 2012 and 2019, a total of 30 operated cases were analyzed with available preoperative ADC data. Receiver operating characteristic (ROC) analysis was used to obtain ADC cutoff values for predicting tumor aggressiveness. The mean and minimum ADC values were significantly lower in the aggressive tumor group than in the stable tumor group (both P < 0.001). ROC analysis showed that a mean cutoff ADC value of 1198 × 10−6 mm2/s and minimum ADC value of 895.5 × 10–6 mm2/s could be used to predict aggressive features of clival chordoma. Subtotal resection, partial resection, and mean and minimum ADC values that were lower than cutoff values were negative predictors of overall survival and progression-free survival. In conclusion, mean and minimum ADC values could be useful in predicting aggressiveness of clival chordoma.
Highlights
Clival chordoma is a rare disease with high recurrence rates even after a combination of surgical resection and radiotherapy
Adjacent neurovascular structures make it difficult to eradicate the tumor surgically[3,4]. To overcome these locally invasive properties of chordoma, several studies have examined the efficacy of chemotherapeutic agents for treating chordoma, but none were successful for clinical u se[5,6,7,8]
We evaluated the aggressiveness of clival chordomas using preoperative apparent diffusion coefficient (ADC) v alues[16] and determined ADC cutoff values to predict tumor progression and recurrence
Summary
Clival chordoma is a rare disease with high recurrence rates even after a combination of surgical resection and radiotherapy. The utility of preoperative ADC values was analyzed for predicting tumor progression and recurrence in patients with clival chordoma. ROC analysis showed that a mean cutoff ADC value of 1198 × 10−6 mm2/s and minimum ADC value of 895.5 × 10–6 mm2/s could be used to predict aggressive features of clival chordoma. Clival chordoma is a rare and slow-growing disease that infiltrates the bone and extends into the adjacent soft tissue, especially to the b rainstem[1] Such chordomas show malignant behavior with high recurrence rates even after treatment with the combination of maximal safe surgical resection and adjuvant radiotherapy[2]. We evaluated the aggressiveness of clival chordomas using preoperative ADC v alues[16] and determined ADC cutoff values to predict tumor progression and recurrence
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