The Influence of Facility Volume and Type on Skull Base Chordoma Treatment and Outcomes

Du, Amy T.; Pang, Ji‐Jie; Victor, Robert; Torabi, Sina J.; Goshtasbi, Khodayar; Kim, Michael G.; Hsu, Frank P.K.; Kuan, Edward C.

doi:10.1016/j.wneu.2022.07.064

Cited by 11 publications

(8 citation statements)

References 46 publications

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“…The NCDB categorizes each treating facility based upon its classification by the CoC Accreditation program, which distinguishes academic programs as those participating in graduate medical education in addition to reporting more than 500 new cancer diagnoses annually, compared to community cancer programs, which report between 100 and 500 new cancer diagnoses each year. These findings are consistent with previous studies that have also demonstrated increased likelihood of undergoing oncologic surgery at high-volume centers [29][30][31][32]. Many studies have also demonstrated superior outcomes in patients receiving cancer treatment at high-volume centers compared to low-volume [32][33][34][35].…”

Section: Discussionsupporting

confidence: 91%

Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer

Ritter,

Yildiz,

Koirala

et al. 2023

Cancers

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Background: Despite recommendations for upfront total laryngectomy (TL), many patients with cT4a laryngeal cancer (LC) instead undergo definitive chemoradiation, which is associated with inferior survival. Sociodemographic and oncologic characteristics associated with TL utilization in this population are understudied. Methods: This retrospective cohort study utilized hospital registry data from the National Cancer Database to analyze patients diagnosed with cT4a LC from 2004 to 2017. Patients were stratified by receipt of TL, and patient and facility characteristics were compared between the two groups. Logistic regression analyses and Cox proportional hazards methodology were performed to determine variables associated with receipt of TL and with overall survival (OS), respectively. OS was estimated using the Kaplan–Meier method and compared between treatment groups using log-rank testing. TL usage over time was assessed. Results: There were 11,149 patients identified. TL utilization increased from 36% in 2004 to 55% in 2017. Treatment at an academic/research program (OR 3.06) or integrated network cancer program (OR 1.50), male sex (OR 1.19), and Medicaid insurance (OR 1.31) were associated with increased likelihood of undergoing TL on multivariate analysis (MVA), whereas age > 61 (OR 0.81), Charlson–Deyo comorbidity score ≥ 3 (OR 0.74), and clinically positive regional nodes (OR 0.78 [cN1], OR 0.67 [cN2], OR 0.21 [cN3]) were associated with decreased likelihood. Those undergoing TL with post-operative radiotherapy (+/− chemotherapy) had better survival than those receiving chemoradiation (median OS 121 vs. 97 months; p = 0.003), and TL + PORT was associated with lower risk of death compared to chemoradiation on MVA (HR 0.72; p = 0.024). Conclusions: Usage of TL for cT4a LC is increasing over time but remains below 60%. Patients seeking care at academic/research centers are significantly more likely to undergo TL, highlighting the importance of decreasing barriers to accessing these centers. Increased focus should be placed on understanding and addressing the additional patient-, physician-, and system-level factors that lead to decreased utilization of surgery.

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Section: Discussionsupporting

confidence: 91%

Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer

Ritter,

Yildiz,

Koirala

et al. 2023

Cancers

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“…The associated surgical morbidity, the aforementioned low rates of GTR, and the importance of achieving the best resection outcome at the first surgical attempt make it mandatory to properly refer patients to high-volume centers. 67 Of 3749 patients, a pooled mean of 80% received photon RT or PBRT. The 5-year OS and PFS analyses for patients undergoing PBRT, photon RT (conventional or stereotactic), or no RT suggest that using PBRT is associated with improved survival outcomes, i.e., up to 86% and 71% of pooled 5-year OS and PFS, respectively.…”

Section: Discussionmentioning

confidence: 99%

The burden of skull base chordomas: insights from a meta-analysis of observational studies

Fiore,

Porto,

Bertani

et al. 2024

Neurosurgical Focus

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OBJECTIVE The aim of this study was to provide a quantitative synthesis of the survival outcomes for patients with skull base chordomas, focusing on the role of 1) the extent of resection (gross-total [GTR] vs non-GTR), 2) the type of surgery (primary vs revision), 3) tumor histology, and 4) the different use of adjuvant therapies (proton beam radiotherapy [PBRT], photon radiotherapy [RT], or none). METHODS A systematic review with a meta-analysis was conducted following the 2020 PRISMA guidelines. Observational studies describing adult and pediatric patient cohorts harboring skull base chordomas were included. The primary outcome measures were represented by the 5-year overall survival (OS) and progression-free survival (PFS) rates. The main intervention effects were represented by the extent of resection (GTR vs non-GTR), type of surgical excision (primary vs revision surgeries), tumor histology, and the different use of adjuvant therapies (PBRT, RT, or none). The pooled estimates were calculated using random forest models. The risk of bias was evaluated using the Joanna Briggs Institute checklist for case series. RESULTS Six hundred forty-four studies were identified through a database and register search. After study selection, 51 studies and 3871 patients were included in the meta-analysis. The overall 5-year OS rate was 73%, which increased to 84% among patients undergoing GTR. The overall 5-year PFS rate was 52%, increasing to 74% for patients receiving GTR. The 5-year OS and PFS rates for patients undergoing PBRT were 86% and 71%, compared with 71% and 54% for patients receiving RT, and 55% and 25% when no adjuvant treatments were used. Patients undergoing their first surgery had 2.13-fold greater chances of being disease-free and 1.4-fold greater chances of being alive at 5 years follow-up compared with patients who received a revision surgery. Patients harboring chondroid chordomas had 1.13- and 1.9-fold greater chances of being alive at 5 years compared with patients with conventional and de-differentiated chordomas, respectively. The overall risk of bias was low in the included studies. CONCLUSIONS The results of this comprehensive meta-analysis highlight the tremendous impact of GTR and adjuvant PBRT on improving OS and PFS of patients harboring skull base chordomas, with better survival rates demonstrated for patients with chondroid tumors. Even in experienced hands, the rate of surgical morbidity remains high. Proper management in high-volume centers is mandatory to reach the expected resection goal at the first surgical attempt and to reduce surgical morbidity. The introduction of the endoscopic endonasal approach was related to improved surgical and functional outcomes.

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“…Du et al in 2022 published an article examining the influence of facility patient volume and outcome. 57 The study demonstrated that academic centres operating on at least seven patients a year with skull base chordoma had superior outcomes compared to units who operated on fewer patients per year. It has also been demonstrated that delivery of radiotherapy in rare tumours like sarcomas, and thus arguably chordomas, is best done at specialised treatment centres.…”

Section: The Multidisciplinary Team Approachmentioning

confidence: 95%

“…Du et al. in 2022 published an article examining the influence of facility patient volume and outcome 57 . The study demonstrated that academic centres operating on at least seven patients a year with skull base chordoma had superior outcomes compared to units who operated on fewer patients per year.…”

Section: Introductionmentioning

confidence: 99%

Proton beam therapy for clival chordoma: Optimising rare cancer treatments in Australia

Mathew,

Gorayski,

Candy

et al. 2024

J of Medical Radiation Sci

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With the anticipated launch of the Australian Bragg Centre for Proton Therapy and Research (ABCPTR) in Adelaide, Australia, proton therapy will become a significant addition to existing cancer treatment options for Australians. The anticipated benefits will be particularly evident in rare cancers such as clival chordomas, a challenging tumour entity due to the anatomical relationship with critical structures, and proven radio‐resistance to conventional radiation therapy. The article synthesises key findings from major studies and evaluates the current evidence supporting various management strategies for clival chordomas. It also considers the influence of institutional volume and multidisciplinary team management on patient outcomes and outlines how high‐quality care can be effectively delivered within the Australian healthcare system, emphasising the potential impact of proton therapy on the treatment paradigm of clival chordomas in Australia.

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The Influence of Facility Volume and Type on Skull Base Chordoma Treatment and Outcomes

Cited by 11 publications

References 46 publications

Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer

Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer

The burden of skull base chordomas: insights from a meta-analysis of observational studies

Proton beam therapy for clival chordoma: Optimising rare cancer treatments in Australia

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