Long-term control of clival chordoma with initial  aggressive surgical resection and gamma knife  radiosurgery for recurrence.
OBJECTIVE
Chordomas are locally destructive tumors with high rates of recurrence, and therapeutic strategies remain controversial. This study analyzed long-term outcomes for clival chordomas after initial aggressive surgical resection and gamma knife radiosurgery for recurrence and investigated clinical factors predicting recurrence.


METHODS
Clinical records were reviewed for 19 consecutive patients (11 men, 8 women; mean age, 43.1 years) with clival chordoma who underwent initial surgical resection using skull base approaches (mean follow-up after surgical resection, 87.2 months). All tumors were aggressively removed, along with the surrounding bone. Four patients were treated with radiotherapy after surgical resection.Recurrent lesions were treated with gamma knife radio surgery or reoperation. Factors predicting tumor recurrence were analyzed, including age, tumor extension, extent of resection and MIB-1 labeling index. Patient status was evaluated using the Karnofsky performance scale (KPS).


RESULTS
Tumor resection was total, subtotal and partial in 14, 4 and 1 patients, respectively. Tumors recurred in 11 patients. Overall, 2- and 5-year progression-free survival rates were 77.9% and 47.9%, respectively. The MIB-1 labeling index was independently associated with recurrence.The optimum cutoff point for the MIB-1 labeling index was 3.44%. All recurrent tumors were totally resected or controlled by gamma knife (mean follow-up after recurrence, 71.2 months). All patients survived and were active (mean KPS at final follow-up, 89.5%).


CONCLUSIONS
Long-term control of clival chordomas was achieved. Recurrent tumors were controlled with gamma knife radiosurgery, since lesions were localized and small after initial aggressive resection. The MIB-1 labeling index can provide important information for predicting tumor recurrence.
Ito
Eiji
E
Department of Neurosurgery, Fukushima Medical University,1 Hikarigaoka, Fukushima 960-1295, Japan.
Saito
Kiyoshi
K
Okada
Takeshi
T
Nagatani
Tetsuya
T
Nagasaka
Tetsuro
T
D000328:Adult; D002648:Child; D002817:Chordoma / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D017567:Karnofsky Performance Status; D019394:Ki-67 Antigen / Q000097:blood; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D018714:Radiotherapy, Adjuvant; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012903:Smell; D016896:Treatment Outcome
D019394:Ki-67 Antigen