title: Predictors of recurrence following resection of intracranial chordomas.
abstract: Management of intracranial chordomas remains challenging, despite improvements in microsurgical techniques and radiotherapy. Here, we analyzed the prognostic factors associated with improved rates of tumor control in patients with intracranial chordomas, who received either gross (GTR) or subtotal resections (STR). A retrospective review was performed to identify all patients who were undergoing resection of their intracranial chordomas at the Ronald Reagan University of California Los Angeles Medical Center from 1990 to 2011. In total, 57 patients undergoing 81 resections were included. There were 24 females and 33 males with a mean age of 44.6 years, and the mean tumor diameter was 3.36 cm. The extent of resection was not associated with recurrence. For all 81 operations, the 1 and 5 year progression free survival (PFS) was 87.5 and 40.4%, and 88.0 and 33.6% for STR and GTR, respectively (p=0.90). Adjuvant radiotherapy was associated with improved rates of PFS (hazard ratio [HR] 0.20; p=0.009). Additionally, age >45 years (HR 5.88; p=0.01) and the presence of visual deficits (HR 7.59; p=0.03) were associated with worse rates of tumor control. Tumor size, sex, tumor histology, and recurrent tumors were not predictors of recurrence. Younger age, lack of visual symptoms on presentation and adjuvant radiotherapy were associated with improved rates of tumor control following surgery. However, GTR and STR produced comparable rates of tumor control. The surgical management of intracranial chordomas should take a conservative approach, with the aim of maximal but safe cytoreductive resection with adjuvant radiation therapy, and a major focus on quality of life.
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Winward
authors.initials: W
authors.lastname: Choy
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Sergei
authors.initials: S
authors.lastname: Terterov
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, CA, USA.
authors.forename: Tania B
authors.initials: TB
authors.lastname: Kaprealian
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Trang
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Nolan
authors.initials: N
authors.lastname: Ung
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: DeSalles
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Lawrance K
authors.initials: LK
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Martin
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Selch
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA.
authors.forename: Marvin
authors.initials: M
authors.lastname: Bergsneider
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Harry V
authors.initials: HV
authors.lastname: Vinters
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Yong
authors.affiliation: Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Fifth Floor, Wasserman Building, Los Angeles, CA 90095-6901, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA. Electronic address: iyang@mednet.ucla.edu.
authors.forename: Isaac
authors.initials: I
authors.lastname: Yang
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002140:California; D002817:Chordoma / Q000473:pathology / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies
keywords: Chordoma; Prognostic factors; Radiation therapy; Radiosurgery; Surgery