Outcomes of the endonasal endoscopic approach for the treatment of Clival chordomas: a single-center experience

Objective: Chordoma is a low-grade malignant tumor that originates from the remnant tissue of the embryonic notochord. Postoperative or definitive radiotherapy has been used to enhance local control. This study aims to assess the outcomes of the expanded EEA for maximal removal of clival chordomas followed by CyberKnife radiosurgery for visualized residual or tumor recurrence. Methods: 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 endoscopic endonasal approach. Patients who underwent combined external and endoscopic approaches or transcranial surgery were excluded. Results: 17 patients were included in this study. Most of them had tumors located in the middle clivus. Regarding radiation therapy (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 on them related to radiation side effect. The 2-year overall survival was 82.4% (Mean S.E. = 1.765, 95% CI = 1.505–2.024), and the progression-free survival (PFS) was 76.5% (Mean S.E. = 3.403, 95% CI = 2.791–4.016). No distal metastasis was reported in our series. Conclusions: This series illustrates that the expanded EEA to resection of skull-base chordomas followed by CyberKnife radiosurgery is an acceptable alternative to proton therapy. The 2-year overall survival was 82.4% and PFS was 76.5%.