title: Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease.
abstract: OBJECTIVE
  Chordoma is a locally invasive tumor with a high tendency for recurrence for which radical resection is generally recommended. To assess the benefits of aggressive treatment of chordomas, the authors compared results in patients treated aggressively at the first presentation of this disease with results in patients who were similarly treated, but after recurrence.
  
  
  METHODS
  Among 36 patients with cervical chordomas who were treated at the authors' institution, 22 underwent primary aggressive treatment (Group A) and 14 were treated secondarily after tumor recurrence (Group B). Two cases were excluded from Group A because of unrelated early deaths and three from Group B because of insufficient pre- or postoperative data. Most tumors were located at the suboccipital level and only eight cases at a level below C-2. Radiotherapy and proton therapy were similarly conducted in both groups of patients. The actuarial survival rates were 80 and 65% at 5 and 10 years, respectively, in Group A patients and 50 and 0% at 5 and 10 years, respectively, in Group B patients (p = 0.049, log-rank test). The actuarial recurrence-free rates were 70 and 35% at 5 and 10 years, respectively, in Group A and 0% at 3 years in Group B (p < 0.0001, log-rank test). The numbers of recurrences per year were 0.15 in Group A and 0.62 in Group B (p > 0.05). All other parameters that were analyzed (patient age, delay before diagnosis, clinical symptoms, chondroid type of lesion, and histological features) did not prove to influence prognosis in a statistically significant manner.
  
  
  CONCLUSIONS
  Aggressive therapy, combining as radical a resection as possible with radiotherapy, seems to improve the prognoses of suboccipital and cervical chordomas when applied at the patient's first presentation with the disease.
authors.affiliation: Department of Neurosurgery, Hôpital Lariboisière, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Carpentier
authors.forename: Marc
authors.initials: M
authors.lastname: Polivka
authors.forename: Alexandre
authors.initials: A
authors.lastname: Blanquet
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lot
authors.forename: Bernard
authors.initials: B
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects; D009777:Occipital Bone; D011379:Prognosis; D061766:Proton Therapy; D012888:Skull Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D011522:Protons
chemical_list: D011522:Protons