Comprehensive Review of Cranial Chordomas Using National Databases in the USA

Area of Science:

• Neuro-oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Cranial chordomas are rare bone tumors requiring complex management.
• Treatment strategies for cranial chordomas have historically been controversial.
• Understanding current treatment patterns and outcomes is crucial for improving patient care.

Purpose of the Study:

• To comprehensively review the evolving patterns of care for cranial chordomas in the USA.
• To analyze clinical characteristics, survival rates, and perioperative outcomes.
• To identify trends in treatment modalities and their impact on patient survival.

Main Methods:

• Analysis of the National Cancer Database (NCDB), Surveillance, Epidemiology, and End Results (SEER) database, and National Surgical Quality Improvement Program (NSQIP) dataset.
• Inclusion of data from 2004-2014 for NCDB and SEER, and 2005-2016 for NSQIP.
• Evaluation of clinical, survival, perioperative characteristics, and surgical morbidity.

Main Results:

• A total of 936 patients from NCDB, 405 from SEER, and 64 from NSQIP were analyzed.
• Surgery was the predominant treatment (86-87%), often combined with radiation therapy (40-45%).
• Proton therapy increased post-2011; surgery was associated with longer operative times, hospital stays, and higher morbidity, yet 5-year survival was 77-80%.

Conclusions:

• Current US patterns show increasing utilization of surgery and radiation for cranial chordomas.
• Combined modality treatment appears to correlate with improved survival trends.
• Despite surgical complexities, outcomes demonstrate a need for continued research in optimizing cranial chordoma management.