Endoscopic endonasal surgery and radiotherapy in skull base chordomas: a 20-year retrospective analysis of long-term outcomes and prognostic factors.

BACKGROUND

For skull base chordomas, two key aspects remain controversial: (1) the necessity of adjuvant RT following gross total resection (GTR) and (2) the comparative long-term efficacy of different RT modalities.

OBJECTIVE

This study aimed to evaluate the effects of endonasal endoscopic surgery, RT, and other variables on progression-free survival (PFS) and overall survival (OS) in patients with skull base chordomas.

METHOD: A retrospective analysis was conducted on 83 patients (2006-2025) treated at the Affiliated Eye Ear Nose and Throat Hospital, Fudan University, to assess the prognosis of skull base chordoma between 2006 and 2025.

RESULTS

Between 2006 and 2014, GTR was achieved in 25.8% of patients. Between 2015 and 2022, GTR was achieved in 50.0% of patients. Multivariate Cox regression analysis revealed several independent prognostic factors. For PFS, GTR, the presence of complications, and a tumor volume <25 cm3 were significantly associated with outcome. For OS, the independent predictors included STR, GTR and complications.

CONCLUSIONS

Surgery remains the primary treatment for skull base chordoma. We therefore recommend pursuing maximal safe resection to achieve GTR whenever feasible. The efficacy of resection is also influenced by the endoscopic endonasal surgery learning curve. Our analysis also revealed tumor volume, and a complicated surgical course as independent prognostic factors. Furthermore, our data may not support the routine use of adjuvant RT following GTR.