Neurosurgery Department

Publication summary: Glioblastoma, the most common primary brain tumor, is associated with a dismal median survival of 12-15 months with current standard of care. Surgery is generally considered the preferred approach for these tumors, but not all tumors are surgically accessible, and local and distant intracranial recurrence is common. Laser Interstitial Thermal Therapy (LITT) is an emerging minimally invasive approach, requiring only a 2 mm incision in the scalp and only a few minutes to perform, which involves implanting a catheter that can heat the tumor to high enough temperatures to kill it. Our team, led by  Sujit Prabhu, M.D., retrospectively reviewed and analyzed data from 69 patients with GBM who received LITT at MD Anderson Cancer Center (2013-20017) in one of the largest single-institution cohort studies to assess the safety and efficacy of this technique for GBM specifically. Results of this study indicated that LITT may confer a survival benefit over nonoperative management in patients for whom surgical resection is not an option. Importantly, the observed increase in progression-free survival among patients who received chemotherapy after LITT suggests that LITT may facilitate improved delivery of chemotherapy to the tumor site. Larger prospective studies to confirm these promising results are warranted. 

Publication summary: Sacral chordomas are primary bone tumors found along the axial skeleton, most commonly arising in the sacrococcygeal region. While en bloc resection is the preferred treatment for sacral chordomas due to the limited response of these tumors to radiation and chemotherapy, the large size of many sacral chordomas at diagnosis and complex anatomy of the sacropelvic region often make this approach difficult and increase the risk of surgical complications. As such, it is important to identify whether perioperative factors, such as surgical complications, predict postsurgical outcomes in these patients. A series of 50 patients who underwent en bloc resection of a sacral chordoma at MD Anderson Cancer Center from January 1995 to June 2016, was reviewed. After a median of 5.3 years of follow-up, our team, led by Laurence Rhines, M.D., found that while negative margin resection was associated with a decreased risk of local recurrence, major complications and reoperation did not significantly impact overall survival, local recurrence, or functional outcome. Therefore, it appears that the inherently high surgical morbidity associated with these invasive operations does not adversely alter the trajectory of survival and recurrence.

Publication summary: While rare and often characterized by slow growth, chondrosarcomas (CSA) are associated with local invasion and destructive growth within the skull base. Moreover, these tumors are difficult to cure and there is little data regarding salvage therapy. Shaan Raza, M.D., and his team conducted a retrospective review of the clinical course and outcomes of 17 patients with recurrent/progressive CSA treated at MD Anderson Cancer Center over a 25-year period. They conducted a survival analysis to identify presentation and treatment-related factors that impact progression and disease-specific survival following 47 recurrence/progression events. In this cohort, high grade histology and prior radiation treatment negatively impacted salvage treatment outcomes. Additionally, though a rare scenario, gross total resection for recurrence following primary treatment was significantly associated with successful outcomes. These findings suggest that careful consideration of histology, systemic disease status, previous treatments, and the anatomic extent of the skull base disease can inform the selection of salvage intervention following recurrence to optimize patient outcomes.