Retrospective Review of Surgical and Adjuvant Treatment Modalities that Affect Skull Base Chordoma Recurrence Rates

e16556 Background: The choice of adjuvant therapy for early-stage USC remains controversial. The objective of this study was to estimate the recurrence rates of patients with surgically resected early-stage USC stratified by observation alone or adjuvant therapy. Methods: A retrospective review of women with surgically-staged stage IA-II USC followed at M.D. Anderson Cancer Center between January 2000 and December 2011. Descriptive statistics were used to summarize the demographic and clinical characteristics of patients. We estimated the cumulative incidence of disease recurrence, overall survival (OS), and recurrence-free survival (RFS) as a function of adjuvant therapy received. Adjuvant therapy groups listed in the Table. Results: 80 patients included in study. 58 patients had stage IA, 14 had stage IB, and 8 had stage II disease. Mean age was 66.4 years. Median follow-up for all patients was 4.83 years (range: 0.02 – 18.16). Cumulative incidence of recurrence for the whole group was 0.18 (95% CI: 0.10 – 0.28) which was reached at 3.96 years and remained at this rate until rising to 0.23 (95% CI: 0.12 – 0.36) at 11.12 years. Adjuvant treatment was not significantly associated with decreased risk of recurrence (Table). RFS at 5 years for the whole population was 0.71 (95% CI: 0.59 – 0.80) and OS at 5 years was 0.76 (95% CI: 0.63 – 0.85). Adjuvant treatment was not significantly associated with RFS or OS. In a subset of stage IA patients, 4 of 27 patients in the observation or cuff alone group recurred compared with 1 of 16 patients in the chemotherapy +/- cuff group (HR 0.48, CI: 0.05 – 4.27, p=0.511). Conclusions: In this study, there were no observed differences between observation and adjuvant treatment modalities in recurrence rates or survival outcomes for patients with early-stage USC. The addition of adjuvant chemotherapy may reduce risk for recurrence in stage IA patients, but further study is needed. [Table: see text]

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Skull base chordoma treated with proton therapy: A systematic review

Surgical Neurology International ◽

10.25259/sni-213-2019 ◽

2019 ◽

Vol 10 ◽

pp. 96 ◽

Cited By ~ 5

Author(s):

Mohammed Alahmari ◽

Yasin Temel

Keyword(s):

Side Effects ◽

Skull Base ◽

Proton Therapy ◽

Search Algorithm ◽

High Energy ◽

Recurrence Rates ◽

Number Of Patients ◽

The Mean ◽

Skull Base Chordoma

Background: Chordoma located in the skull base is usually a challenging surgical condition. It is often not possible to achieve gross total resection. Residual tumors have been treated with adjuvant focal radiation therapy employing high-energy particles most commonly through proton beam. In this review, we systematically analyzed indications and outcomes of this treatment with respect to local control rates of the lesion and factors determining recurrence of skull base chordomas. In addition, we collected data on treatment-associated radiation-induced side effects. Methods: In line with the PRISMA guidelines, the authors performed a literature search algorithm for relevant articles using three databases: PubMed, Embase, and Cochrane. Inclusion and exclusion criteria were applied to evaluate all identified studies published between 1980 and 2018. Results: Our review included 11 studies for analysis (n = 511 patients). The mean age of the study population was 47.3 ± 5.8 years. The mean dose of postsurgical irradiation at the time of initial treatment was 71.1 ± 3.1 Gy. The mean follow-up duration was 45.0 ± 17.5 months. Within this follow-up duration, recurrence occurred in 26.8% of the patients. The mean time to recurrence was 34.5 ± 15.2 months. A significant number of patients experienced side effects varying from Grade 1 (mild dermatitis) to Grade 4 (temporal lobe necrosis and visual disorders). Conclusion: Despite advances in proton therapy, recurrence rates in skull base chordoma remain high. The toxicity of proton therapy may be more prevalent than generally thought. Unfortunately, there is substantial variation in the methods of data reporting.

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Retrospective Review of 24 Cases of Head and Neck Cancer with Skull Base Invasion

Skull Base ◽

10.1055/s-2007-981750 ◽

2007 ◽

Vol 17 (S 2) ◽

Author(s):

Federico Ampil ◽

Cherie Nathan ◽

Gloria Caldito ◽

Anil Nanda ◽

Timothy Lian

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Skull Base ◽

Neck Cancer ◽

Retrospective Review

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RARE-32. PEDIATRIC METASTATIC SKULL BASE CHORDOMA WITH TP53 MUTATION – A CASE REPORT AND REVIEW OF THE LITERATURE

Neuro-Oncology ◽

10.1093/neuonc/noaa222.742 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii449-iii449

Author(s):

Akira Shimada ◽

Kazuhiko Kurozumi ◽

Kiichiro Kanamitsu ◽

Hisashi Ishida Ishida ◽

Kaori Fujiwara ◽

...

Keyword(s):

Skull Base ◽

Tp53 Mutation ◽

Cranial Nerves ◽

Gamma Knife Radiosurgery ◽

Biological Behavior ◽

Maximum Diameter ◽

Cervical Lymph Nodes ◽

First Choice ◽

Systemic Metastasis ◽

Skull Base Chordoma

Abstract Chordoma is an uncommon bone tumor arising from notochordal remnant, which accounts for 1–4% of all bone malignancies. It commonly occurs along the cranial-spinal axis, and skull base is one of most frequent sites, representing 35–49% of all chordoma cases. Surgical resection is widely accepted as the first choice of treatment. There are only limited number of reports about pediatric chordoma cases, and its biological behavior including genetic backgrounds were largely unknown. Here, we present a 5 year-old girl with a large aggressive skull base chordoma of 6 cm in maximum diameter, which eventually had multiple systemic metastasis. We initially tried chemotherapy based on the protocol for the osteosarcoma, but in vain. Because the tumor was highly vascularized on angiography, after embolization of the feeding arteries and bilateral internal maxillary arteries, endoscopic endonasal surgery was performed. The tumor was sufficiently removed, achieving effective mass reduction, and the residual tumors involving the lower cranial nerves and craniocervial junction were additionally treated with Gamma Knife radiosurgery. However, one month later, it showed systemic metastasis to bilateral cervical lymph nodes and lung. We tried chemotherapy with nivolmab and imatinib for this patient, whereas they showed the partial effect. The genetic analysis revealed somatic TP53 c.569C>T, (p.P190L) mutation in chordoma specimen. In the past literature, we found only one study of the adult chordoma cases, in which majority of the patients had somatic TP53 mutation (p.P72R). Further investigation with large number of the cases is essential to clarify the molecular biology of pediatric chordomas.

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Radiomics and Dosiomics for Predicting Local Control after Carbon-Ion Radiotherapy in Skull-Base Chordoma

Cancers ◽

10.3390/cancers13020339 ◽

2021 ◽

Vol 13 (2) ◽

pp. 339

Author(s):

Giulia Buizza ◽

Chiara Paganelli ◽

Emma D’Ippolito ◽

Giulia Fontana ◽

Silvia Molinelli ◽

...

Keyword(s):

Prognostic Factors ◽

Skull Base ◽

Local Control ◽

Tumour Progression ◽

Risk Groups ◽

Carbon Ion Radiotherapy ◽

Survival Models ◽

Carbon Ion ◽

Combined Models ◽

Skull Base Chordoma

Skull-base chordoma (SBC) can be treated with carbon ion radiotherapy (CIRT) to improve local control (LC). The study aimed to explore the role of multi-parametric radiomic, dosiomic and clinical features as prognostic factors for LC in SBC patients undergoing CIRT. Before CIRT, 57 patients underwent MR and CT imaging, from which tumour contours and dose maps were obtained. MRI and CT-based radiomic, and dosiomic features were selected and fed to two survival models, singularly or by combining them with clinical factors. Adverse LC was given by in-field recurrence or tumour progression. The dataset was split in development and test sets and the models’ performance evaluated using the concordance index (C-index). Patients were then assigned a low- or high-risk score. Survival curves were estimated, and risk groups compared through log-rank tests (after Bonferroni correction α = 0.0083). The best performing models were built on features describing tumour shape and dosiomic heterogeneity (median/interquartile range validation C-index: 0.80/024 and 0.79/0.26), followed by combined (0.73/0.30 and 0.75/0.27) and CT-based models (0.77/0.24 and 0.64/0.28). Dosiomic and combined models could consistently stratify patients in two significantly different groups. Dosiomic and multi-parametric radiomic features showed to be promising prognostic factors for LC in SBC treated with CIRT.

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Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

Journal of Clinical Medicine ◽

10.3390/jcm10132803 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2803

Author(s):

Carolin Czauderna ◽

Martha M. Kirstein ◽

Hauke C. Tews ◽

Arndt Vogel ◽

Jens U. Marquardt

Keyword(s):

Clinical Care ◽

Treatment Options ◽

Treatment Strategies ◽

Specific Treatment ◽

Growth Factor Receptor ◽

Treatment Modalities ◽

Precision Oncology ◽

Recurrence Rates ◽

Isocitrate Dehydrogenase 1 ◽

Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

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Does a polyurethane film improve the burn healing properties of an ionic silver hydro-fiber dressing in the treatment of minor partial-thickness burns? A retrospective review of medical records comparing healing time, patient satisfaction and medical costs in two different treatment modalities

Burns Open ◽

10.1016/j.burnso.2021.01.001 ◽

2021 ◽

Vol 5 (2) ◽

pp. 50-55

Author(s):

Sandra Johansson Vaage ◽

Christina Brudvik ◽

Hallvard Vindenes ◽

Torbjørn Hiis Bergh ◽

Knut Steen ◽

...

Keyword(s):

Patient Satisfaction ◽

Retrospective Review ◽

Medical Records ◽

Medical Costs ◽

Healing Time ◽

Treatment Modalities ◽

Ionic Silver ◽

Partial Thickness ◽

Polyurethane Film ◽

Partial Thickness Burns

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Lateral skull base surgery: a complicated pursuit?

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000436 ◽

2007 ◽

Vol 122 (3) ◽

pp. 221-229

Author(s):

V C Cousins

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Treatment Modalities ◽

Published Data ◽

Know How ◽

Team Assessment ◽

Pathological Conditions ◽

Lateral Skull Base ◽

Wide Range ◽

Multi Disciplinary Team

AbstractThe management of lesions of the lateral skull base is a highly sophisticated branch of surgery generally performed by otolaryngology–head and neck surgeons as part of a multi-disciplinary team. Assessment of patients with diseases affecting the lateral skull base can be complex, as can the application of the various treatment modalities and the management of the expected and unexpected side effects of that treatment.A wide range of pathological conditions occur in the lateral skull base. Many operations and procedures have been described for dealing with them. There is not necessarily one correct solution to the management of any particular problem in the skull base, with multiple factors to be considered in planning and intervention.As surgeons, we need to know how our own results and outcomes compare with pooled, published data concerning the implications and complications occurring as a result of intervention, in order to better advise our patients on their management.

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