Abstract
To clarify the need for post-operative radiation treatment in skull base chondrosarcomas (SBCs). 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 105months (range, 9-376). 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). 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.
Highlights
Skull base chondrosarcoma (SBC) is a cartilaginous malignant neoplasm arising from a synchondrosis of the skull base
Maximal safe resection is the preferred treatment strategy; the location and infiltrative nature of the tumor into the skull base and possible involvement of critical adjacent neurovascular structures makes surgery challenging in many cases resulting in a low rate of gross total resection (GTR).[10,12]
The primary goal of this study was to evaluate the role of upfront radiotherapy for the management of SBC, and try and discern if an optimal treatment strategy exists
Summary
Skull base chondrosarcoma (SBC) is a cartilaginous malignant neoplasm arising from a synchondrosis of the skull base. Conventional chondrosarcomas are histopathologically classified into grade I, II, and III based on mitotic rate, cellularity, and nuclear size.[1] Typically, grade I and II tumors behave indolently, while grade III tumors typically exhibit a more aggressive disease course.[2,3,4] There are 5 nonconventional variants: juxtacortical, clear cell, myxoid, mesenchymal, and dedifferentiated, in which the first 3 subtypes are presumed to be indolent and behave to grade I–II SBCs, while the other 2 are considered high-grade.[5,6,7,8] The majority of SBCs are grade I or II, expected to exhibit indolent behaviors.[2,4,9,10]. Maximal safe resection is the preferred treatment strategy; the location and infiltrative nature of the tumor into the skull base and possible involvement of critical adjacent neurovascular structures makes surgery challenging in many cases resulting in a low rate of gross total resection (GTR).[10,12] it may be difficult on postoperative imaging to be confident GTR was achieved
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