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Chordomas and chondrosarcomas of the skull base: comparative analysis of clinical results in 30 patients

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Abstract

Chordomas and chondrosarcomas occur rarely in the skull base and have been often considered commonly with respect to the management. The aim of this study was to investigate the clinical results in each series of these tumors and analyze comparative outcome. Between 1991 and 2005, 30 consecutive patients with pathological diagnosis of chordoma (n = 19) or chondrosarcoma (n = 11) of the skull base were managed by multimodal treatment combining surgical resection with conventional photon radiotherapy and/or gamma knife radiosurgery. A retrospective analysis was conducted on these patients (aged 3 to 69 years; mean age of 37.3 years; 17 females and 13 males; mean follow-up of 56.1 months). Four deaths occurred among the patients with chordoma. The progression-free survival rate at 3 and 5 years was 61.5 and 40.0% in chordoma. In contrast, no mortalities were observed, and there was only one recurrence among the patients with chondrosarcoma. The progression-free survival rate at 3 and 5 years was 88.9 and 80.0% in chondrosarcoma. Among 15 survivors with chordoma, four patients were suffering from severe disability with progressive disease. On the other hand, most patients with chondrosarcoma harbored stable disease and less disabling symptoms except one instance of recurrence. As the biological behavior of chordoma is much more aggressive than that of chondrosarcoma in the skull base, one should make a distinction between these entities to plan an optimal treatment strategy.

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Authors and Affiliations

  1. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Young Hyun Cho, Jeong Hoon Kim, Jung-Kyo Lee & Chang Jin Kim

  2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Shin Kwang Khang

  3. Department of Neurosurgery, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea

    Jeong Hoon Kim

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  1. Young Hyun Cho
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Correspondence to Jeong Hoon Kim.

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Comments

Gabriele Schackert, Dresden, Germany

This article is a retrospective study on chordomas and chondrosarcomas reporting the experience of a single institution. Thirty consecutive patients (19 with chordomas, 11 with chondrosarcomas) have been enrolled in the study. Patients’ histories, clinical symptoms, location of the lesions, surgical approaches, radiotherapy/radiosurgery, and outcome have been thoroughly investigated. The data of this investigation demonstrate again that the biological behavior of chordomas is much more aggressive than that of chondrosarcomas of the skull base and that a careful interdisciplinary decision making is mandatory for a successful treatment of these lesions. The authors advise a more aggressive treatment for chordomas than for chondrosarcomas in combining maximal resection with radiotherapy or radiosurgery. This article is of great importance and covers an interesting topic in the neurosurgical field. The series is large; all important aspects are addressed. The authors call for maximal resection of chordomas. The limitation of complete resection is related to the location of the lesions. The combination of different treatment modalities, therefore, is doubtless the only way for a successful therapy. The benign behavior of chondrosarcomas and their known radioresistance might justify a more restrictive management with surgery as the treatment of choice.

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Cho, Y.H., Kim, J.H., Khang, S.K. et al. Chordomas and chondrosarcomas of the skull base: comparative analysis of clinical results in 30 patients. Neurosurg Rev 31, 35–43 (2008). https://doi.org/10.1007/s10143-007-0099-z

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  • DOI: https://doi.org/10.1007/s10143-007-0099-z

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