2025 Proffered Presentations
S055: CLINICAL OUTCOMES FOLLOWING SURGERY, RADIOTHERAPY, AND MEDICAL THERAPY FOR CLIVAL CHORDOMA
Thomas Hanks, BS; Spencer Raub, BA; Kyly Hiatt, BS; Zirun Zhao, MD; Jessica Eaton, MD; Kaity Hartl, MS, PAC; Dominic Nistal, MD; Fatima El-Ghazali, MD; Aria Jamshidi, MD; Jacob Ruzevick, MD; Samuel Emerson, MD, PhD; Manuel Ferreira, MD, PhD; University of Washington
Introduction: Skull base chordoma is a pathology associated with high morbidity and limited treatment options. The current standard of care is maximal surgical resection with adjuvant radiotherapy. While long-term control is achieved for some patients, durable disease remission is heavily dependent on initial extent of resection and completion of adjuvant radiation.
Objective: To compare the long-term outcomes of clival chordoma in patients undergoing maximal surgical resection and postoperative radiotherapy as well as identification of outcomes of patients requiring salvage medical therapy.
Methods: A retrospective, single-center cohort study of patients undergoing surgical resection for clival chordoma from 1994 to 2022 was performed.
Results: A total of 80 patients were included for study with an average follow-up of 53.8 months. A total of 56% of the cohort were men and the average age of all patients was 44.3 years. The average tumor volume was 20.6 cm3. The most common presenting symptom was diplopia. Given the time range of patient inclusion, the most common surgical approach was craniotomy (n=48, 60%) followed by endoscopic transsphenoidal approach (n=32, 37.5%), and combined open/endoscopic approach (n=2, 2.5%). Gross total resection was achieved in 36 (45%) patients. In the 44 (55%) patients who underwent subtotal resection, 32 (40%) required an additional surgical resection, and 9 (11.3%) required three or more resections. Postoperative radiotherapy was performed in 59 (73.8%) patients with proton radiotherapy being the most common treatment modality (69.5%). Tumor recurrence occurred in 6 (16.7%) patients with prior GTR, while 15 (34.1%) patients previously undergoing STR had progression of disease (p = 0.033, Figure 1). Outcomes following either GTR or STR were improved with adjuvant radiotherapy (p < 0.0001, Figure 2). GTR at the time of the index surgery significantly improved the rate of overall mortality as compared to STR (p = 0.041, Figure 3). Four patients in the cohort were treated with medical therapy for multiply-recurrent tumors who were not a candidate for additional surgery or radiation. Agents included afatinib, imatinib, etoposide, adriamycin, and ifosfamide. Of this subgroup, 1 case experienced disease stability. Two patients died within two years of initiation of medical therapy.
Conclusion: Extent of resection and radiotherapy are significant risk factors for disease recurrence and overall mortality. Outcomes remain poor in the setting of multiply-recurrent lesions requiring salvage medical therapy.
Figure 1: Progression/Recurrence Free Survival by Extent of Resection
Figure 2: Recurrence Free Survival Based on Radiotherapy Status
Figure 3: Overall Survival by Extent of Resection
