Current surgical outcomes for cranial base chordomas: cohort study of 95 patients.

Abstract

Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥ 70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS.