Management of Skull Base Chordomas and Chondrosarcomas: A Single-Institution Experience

Objectives: To analyze treatment outcomes for patients with skull base chordomas and chondrosarcomas.

Patients and Methods: Retrospective review of a prospectively maintained skull base database was performed to identify patients with skull base chordoma and chondrosarcoma. 13 patients with skull base chordoma [median age 49 years (range: 14–69 years); 7 females: 6 males] underwent a total of 21 surgical interventions (10 endoscopic, 11 open). 12 patients with skull base chondrosarcoma [median age: 38.5 years (range: 33–71 years; 9 females: 3 males] underwent a total of 20 surgical interventions (15 open, 5 endoscopic). In total, 15 patients underwent adjuvant radiotherapy (8 proton beam, 6 fractionated radiotherapy, 1 GK-SRS). Three patients are currently awaiting radiotherapy (one chordoma and two chondrosarcoma).

Results: Six of the seven patients with chordomas who underwent aggressive surgical resection followed by early adjuvant radiotherapy had no evidence of progression over the follow-up period of 5 years (r = 0.5–13 years). All seven patients with chondrosarcoma who underwent surgical resection and early adjuvant radiotherapy had stable disease during the follow-up period (median: 2.5 years; r = 0.5–13 years). There were two perioperative mortalities in this series. Postoperative morbidities included CSF leak (2), cranial nerve palsies (6), hormone imbalance (1), postoperative extradural hematoma (1) and brain stem infarct (2). We will present progression free and overall survival curves and statistics for these patients.

Conclusion: Skull base chordomas and chondrosarcomas present a management challenge and require a multidisciplinary approach with multimodal surgical and oncological strategies. Better outcomes are achieved with definitive surgery followed by early adjuvant radiotherapy.