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Clival chordoma: a single-centre outcome analysis

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

The treatment of clival chordomas remains challenging. Total tumour resection is often impossible without hampering adjacent anatomical structures and causing functional sequelae. On the other hand, chordomas show limited response to non-surgical treatment modalities. Up to now, no well-established interdisciplinary treatment algorithms for clival chordomas exist. In this regard, we analysed the data from all patients that underwent interdisciplinary treatment for clival chordoma in our institution over the last 10 years.

Method

Retrospective report of all patients treated at the authors’ institution from 2005 to 2015.

Results

Thirteen patients underwent 24 surgeries, of which 2 (8%) were gross total resections and 22 (92%) incomplete resections. Neurological deterioration, endocrinological disturbances and other surgical complications were observed in six (25%), three (13%) and nine (38%) cases, respectively. Three surgeries (13%) led to an improvement of the initial preoperative neurological condition. All patients were discussed on the interdisciplinary tumour board and all underwent one type of radiotherapy following initial surgery: proton beam in 11 cases (85%) and photon beam in two (15%) cases. In the course of their recurrent disease, three patients (23%) received systemic therapy (imatinib, pazopanib and nivolumab). One patient received a personalised cellular immunotherapy. One patient (8%) was lost to follow-up. Of the remaining 12 patients, four patients (33%) died in the period of analysis; all deaths were chordoma-related. The 5-year cumulative survival rate was 83% (52–97%, CI 95%), 5-year progression-free survival rate was 53% (26-79%, CI 95%). The eight patients (66%) still alive had favourable outcome (KPS, 90 ± 10.7%). SF36 analysis among the survivors revealed 43 points for the Physical Component Summary (12% above, 38% at and 50% below the general population norm) and 47 points for the Mental Component Summary (25% above, 38% at and 38% below).

Conclusions

Our patients show a low rate of gross total resection but an outcome well comparable to other published results. This emphasises the importance of interdispiplinary treatment strategies, with surgery supplying maximal safe resection and avoiding severe neurological deficit, allowing patients to undergo adjusted radiotherapy and other treatment options in a good condition.

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Authors and Affiliations

  1. Division of Neurosurgery, Geneva University Hospitals and University of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland

    Max Jägersberg, Amir El Rahal, Philipp Dammann & Karl Schaller

  2. Department of Neurosurgery, Essen University Hospital, University of Duisburg-Essen, Essen, Germany

    Philipp Dammann

  3. Department of Pathology and Immunology, Division of Clinical Pathology, Geneva University Hospitals of Geneva, Geneva, Switzerland

    Doron Merkler

  4. Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland

    Damien Charles Weber

Authors
  1. Max Jägersberg
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  2. Amir El Rahal
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  3. Philipp Dammann
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  4. Doron Merkler
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  5. Damien Charles Weber
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  6. Karl Schaller
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Corresponding author

Correspondence to Max Jägersberg.

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No funding was received for this research.

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None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective type of study formal consent is not required.

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Jägersberg, M., El Rahal, A., Dammann, P. et al. Clival chordoma: a single-centre outcome analysis. Acta Neurochir 159, 1815–1823 (2017). https://doi.org/10.1007/s00701-017-3163-7

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  • DOI: https://doi.org/10.1007/s00701-017-3163-7

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