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

Objectives : Chordoma is a locally aggressive tumor. The aim of this study is to assess the efficacy of different surgical approaches and adjuvant radiation modalities used to treat these patients. Design : A meta-analysis Main Outcome Measures : Overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS). Results : The 5-year OS and PFS rates of the whole cohort ( n = 438) were 75% and 65.7%, respectively. The 5-year DSS for patients who underwent open surgery and endoscopic surgery was 45% and 46%, respectively ( p = 0.98); PFS was 94% and 83%, respectively ( p = 0.2). 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). For patients who had total resection the 5-year OS and DSS were 90% and 92%, respectively. Patients undergoing partial resection without adjuvant radiotherapy, had 5-year OS of 42% and DSS of 46%, 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. Conclusions : Patients undergoing total resection have the best outcome, while adjuvant radiation therapy improves the survival of patients undergoing partial resection. Open and endoscopic approaches have comparable results and complication rates. In view of the advantages of minimally invasive techniques, endoscopic surgery appears the best surgical approach for this disease.