Turkish Neurosurgery
Muge Akmansu1, Gokhan Kurt2, Volkan Demircan1, Ertugrul Senturk1
1Gazi University Medical Faculty, Radiation Oncology, Ankara,
2Gazi University Medical Faculty, Neurosurgery, Ankara,
DOI: 10.5137/1019-5149.JTN.24406-19.4

Aim:Chordomas are known as rare malign tumors typically present in the skull base, axial skeleton or sacrococcygeal region. Although treatment options include surgery, radiotherapy and chemotherapy, there is no consensus on an optimal approach. Our research aims at discussing the optimal and newer treatment options based on clinical research of 16 chordoma patients.Material and Methods:Data of 16 chordoma patients diagnosed and treated between 1999 and 2017 in Gazi University Faculty of Medicine has been collected through patients? files and the electronic database of hospital records. SPSS (version 22.0) file was created incorporating all the data available. Statistical analysis was also applied to evaluate the correlation between the progression free survival and treatment modalities.Results:The median follow-up time was 51.7 months. Among participants, 9 out of 16 patients were women (56.3%). Meanwhile, 50% of the patients had tumors with intracranial location, whereas other 50% of the sample had spinal (n=5) and sacral (n=3) chordoma. Recurrence was observed in 50% of patients, while the median recurrence time equaled to 27.6 months. Treatment modalities, tumor size, intra or extracranial location of tumor, subtotal or grosstotal resection of tumor, radiotherapy dose, age, gender and radiotherapy techniques were not associated with recurrence in multivariate analysis. 2 patients are still under chemoterapy agents (imatinib, bevacizumab) without recurrence of the disease. Conclusion:Despite the fact that surgery remains to be the cornerstone of treatment, total resection is not reasonable for all patients. For this reason, adjuvant treatment for ensuring local control is highly important. If the residual tumor is of a small volume, SBRT may provide more advantages. As for newer options, targeted or chemotheapeutic agents may be benificial for maintanence therapy. However, considering the rare status and prevalence of the disease, randomized controlled phase 3 studies for optimal adjuvant approaches are not available at the moment. Still, our clinical awareness about chordomas is based on our series. Therefore, aggressive multi-modality treatment options can be applied in the adjuvant therapy.

Corresponding author : Volkan Demircan