Initial Management of Skull Base Chordomas: Does Early Access to Multidisciplinary Care Affect Outcome?

Background: The treatment of skull base chordomas increasingly requires multi-modality paradigms involving surgery, radiotherapy (XRT) and chemotherapy for selected cases.

Furthermore, optimal surgical management entails the use of the full spectrum of approaches ranging from expanded endoscopic approaches to open approaches. With changes in health care and patient access, an increasing number of tumors are initially managed outside of multidisciplinary programs.

Objective: To compare outcomes in skull base chordoma patients presenting to The University of Texas M.D. Anderson Cancer Center with initial disease (ID) versus progressive/persistent disease (PD) to determine if early access to multidisciplinary care affects progression free survival (PFS).

Methods: A retrospective chart review of prospectively accrued data was performed on 51 patients treated from 1993 to 2013. The cohort was divided into two sub-cohorts: 1) Those patients with progressive/persistent disease (PD) after initial treatment (biopsy or surgery +/− radiation) (n = 30) 2) Patients who underwent initial treatment at our institution (n = 21). Kaplan-Meier analysis was performed for PFS and OS. A secondary analysis was performed to identify if presentation after surgery/biopsy alone or surgery + XRT affected PFS.

Results: Presentation with persistent/progressive disease was associated with a negative trend in mean PFS (67.4 months vs 92.1 months, p = 0.31). When analyzed separately, presentation with PD after surgery was associated with a negative trend in mean PFS (69.6 months vs 132.6 months, p = 0.47) while biopsy alone was not. A significant negative effect on PFS was seen in the cohort presenting after radiation therapy (p < 0.05).

Conclusions: The results from this study place increasing emphasis on the initial management of this complex disease and the importance of patient access to multi-disciplinary care programs in situations where initial diagnostic imaging implies the diagnosis of chordoma.