Treatment and Outcome of Patients with Skull Base Chordoma: A Meta-analysis

ObjectiveChordoma is a locally aggressive tumor. The aim of this study was to assess the efficacy of different surgical approaches and adjuvant radiation modalities used to treat these patients. DesignMeta-analysis. Main Outcome MeasuresOverall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS). ResultsThe 5-year OS and PFS rates of the whole cohort (n=467) were 86% and 65.7%, respectively. The 5-year DSS for patients who underwent open surgery and endoscopic surgery was 45% and 49%, respectively (p=0.8); PFS was 94% and 79%, respectively (p=0.11). The 5-year OS of patients treated with surgery followed by adjuvant radiotherapy was 90% compared with 70% of those treated by surgery alone (p=0.24). Patients undergoing partial resection without adjuvant radiotherapy had a 5-year OS of 41% and a DSS of 45%, significantly lower than in the total-resection group (p=0.0002 and p=0.01, respectively). The complication rates were similar in the open and endoscopic groups. ConclusionsPatients undergoing total resection have the best outcome; adjuvant radiation therapy improves the survival of patients undergoing partial resection. In view of the advantages of minimally invasive techniques, endoscopic surgery appears an appropriate surgical approach for this disease.