Alsayed Ahmed, Alrasheed Abdulaziz S, Aljabab Saif, Alshareef Mohammad, Yahya Buthaina Jaber, Alharbi Abdulmajeed, Alroqi Ahmad, Albaharna Hussain, Alromaih Saud, Alayed Yasir, Alqurashi Ashwag, Alsaleh Saad, Ajlan Abdulrazag
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Radiation Oncology Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
J Neurol Surg B Skull Base. 2023 Dec 4;85(Suppl 2):e57-e63. doi: 10.1055/a-2198-9169. eCollection 2024 Oct.
Chordoma is a low-grade malignant tumor that originates from the remnant tissue of the embryonic notochord. Postoperative or definitive radiotherapy (RT) has been used to enhance local control. This study aims to assess the outcomes of the expanded endoscopic endonasal approach (EEA) for maximal removal of clival chordomas followed by RT for visualized residual or tumor recurrence. A retrospective review was performed on consecutive patients with clival chordoma who underwent endoscopic endonasal resection in the otorhinolaryngology and neurosurgery departments, between 2016 and 2021. We included all patients with pathologically confirmed clival chordoma who were treated using the EEA. Patients who underwent combined external and endoscopic approaches or transcranial surgery were excluded. Seventeen patients were included in this study. Most of them had tumors located in the middle clivus. Regarding RT, the majority of patients underwent postoperative RT. Almost half of them underwent CyberKnife (CK) RT. None of them had severe toxicities (grade 3 or higher). Three patients died, resulting in a mortality rate of 17.6% none of them related to radiation side effect. The 2-year overall survival was 82.4% (mean standard error [SE] = 1.765, 95% confidence interval [CI] = 1.505-2.024), and the progression-free survival (PFS) was 76.5% (mean SE = 3.403, 95% CI = 2.791-4.016). No distal metastasis was reported in our series. This series demonstrates that expanded endoscopic endonasal approach (EEA) for the resection of skull base chordomas, followed by CyberKnife radiosurgery, presents a viable alternative to proton beam therapy; however, further research is necessary to directly compare these modalities.
脊索瘤是一种起源于胚胎脊索残余组织的低度恶性肿瘤。术后或根治性放疗（RT）已被用于加强局部控制。本研究旨在评估扩大经鼻内镜入路（EEA）最大限度切除斜坡脊索瘤后再行放疗以处理可视化残留或肿瘤复发的效果。
对2016年至2021年间在耳鼻喉科和神经外科接受经鼻内镜切除术的连续性斜坡脊索瘤患者进行了回顾性研究。我们纳入了所有经病理证实为斜坡脊索瘤且采用EEA治疗的患者。排除了接受外部与内镜联合入路或经颅手术的患者。
本研究纳入了17例患者。他们中的大多数肿瘤位于斜坡中部。关于放疗，大多数患者接受了术后放疗。几乎一半的患者接受了射波刀（CK）放疗。他们均未出现严重毒性反应（3级或更高）。3例患者死亡，死亡率为17.6%，均与放疗副作用无关。2年总生存率为82.4%（平均标准误[SE]=1.765，95%置信区间[CI]=1.505 - 2.024），无进展生存率（PFS）为76.5%（平均SE = 3.403，95% CI = 2.791 - 4.016）。我们的系列研究中未报告远处转移。
本系列研究表明，扩大经鼻内镜入路（EEA）切除颅底脊索瘤后再行射波刀放射外科治疗，是质子束治疗的一种可行替代方案；然而，需要进一步研究以直接比较这些治疗方式。
