Proposed treatment paradigm for intracranial chondrosarcomas based on multidisciplinary coordination.

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Proposed treatment paradigm for intracranial chondrosarcomas based on multidisciplinary coordination.

World Neurosurg. 2017 Oct 12;:

Authors: Li D, Weng JC, Zhang GJ, Hao SY, Tang J, Zhang LW, Wang L, Wu Z, Jia W, Zhang JT

Abstract
OBJECTIVES: There was no consensus regarding the treatment of intracranial chondrosarcoma (CSA). The study aimed to evaluate the adverse factors for progression-free survival (PFS) and overall survival (OS), and propose a treatment strategy for CSA.
METHODS: The clinical chart and radiographic data of 106 consecutive cases (mesenchymal and conventional CSA in 18 and 88 patients, respectively) of surgically treated CSAs were retrospectively reviewed.
RESULTS: Gross total resection was achieved in 43 patients (40.6%), and adjuvant radiotherapy was administrated in 45 patients. After a mean follow-up duration of 47.8 months, 38 patients (37.3%) experienced recurrence. PFS and disease-specific OS at 5 years was 57.7% and 74.4%. Independent adverse factors for PFS were prior surgery (Hazard Ratio [HR] 2.261, p=0.028), increased lesion size (HR 1.298, p=0.026), extent of surgical resection (HR 3.226, p<0.001), malignant pathology (HR 2.018, p=0.003), and postoperative radiotherapy (HR 3.246, p=0.001). Stereotactic radiosurgery subgroup presented best 5-year PFS of 88.9%, and linear accelerator prolonged the mean PFS time (57.0 months) than no radiation (38.1 months). In incomplete resection subgroup (n=63), radiotherapy significantly benefited to tumor control (HR 2.101, p=0.016). Extent of surgical resection (HR 1.797, p=0.026) and malignant pathology (HR 1.717, p=0.030) were associated with OS.
CONCLUSIONS: Intracranial CSAs were not completely amendable by surgery alone. GTR as far as possible plus radiation was necessary for mesenchymal CSA and conventional CSA with active growth or residual. Stereotactic radiosurgery was alternative if the proton therapy was unavailable. Future study of large cohort was required to verify our findings.

PMID: 29033377 [PubMed - as supplied by publisher]

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