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Primary and radiation induced skull base osteosarcoma: a systematic review of clinical features and treatment outcomes

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Abstract

Purpose

We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced skull-base osteosarcoma (SBO).

Methods

PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Papers including SBO cases and sufficient clinical outcome data were included. A comprehensive clinical characteristic review and survival analysis were also conducted.

Results

Forty-one studies describing 67 patients were included. The median age was 31 years (male = 59.7%). The middle skull-base was most commonly involved (52.7%), followed by anterior (34.5%) and posterior (12.7%) skull-base. Headache (27%), exophthalmos (18%), and diplopia (10%) were common presenting symptoms. Sixty-eight percent of patients had primary SBO, while 25% had radiation-induced SBO. Surgery was the main treatment modality in 89% of cases. Chemotherapy was administered in 65.7% and radiotherapy in 50%. Median progression-free survival (PFS) was 12 months, and the overall 5-year survival was 22%. The five-year survival rates of radiation-induced SBO and primary SBO were 39% and 16%, respectively (P < 0.05).

Conclusion

SBO is a malignant disease with poor survival outcomes. Surgical resection is the primary management modality, in conjunction with chemotherapy and radiotherapy. Radiation-induced SBO has a superior survival outcome as compared to its primary counterpart. Complete surgical resection showed a statistically insignificant survival benefit as compared to partial resection.

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Data availability

All authors confirm the appropriateness of all datasets and software used for supporting the conclusion.

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Authors and Affiliations

  1. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Othman Bin Alamer

  2. Texas A&M University College of Medicine, Houston, TX, USA

    Ali S. Haider

  3. McGovern Medical School at University of Texas Health, Houston, TX, USA

    Maryam Haider

  4. University of Texas Medical Branch School of Medicine, Galveston, TX, USA

    Navraj S. Sagoo

  5. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

    Faith C. Robertson

  6. Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA

    Eliel N. Arrey

  7. Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA

    Salah G. Aoun & Tarek Y. El Ahmadieh

  8. Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kenny Yu

  9. Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

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Contributions

All authors contributed to the study conception and design. The study idea was proposed by [ASH] and [TYEA]. The literature search, articles screen, and data extraction were perfumed by [OBA], [ASH], [NSS], and [TYEA]. Data analysis was performed by [OBA]. The first draft of the manuscript was drafted by [OBA, ASH, NSS]. All authors critically revised and edited the first draft and commented on all versions of the manuscript. The project was supervised by [TYEA] and [AAC-G]. All authors read and approved the final manuscript.

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Correspondence to Tarek Y. El Ahmadieh.

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Bin Alamer, O., Haider, A.S., Haider, M. et al. Primary and radiation induced skull base osteosarcoma: a systematic review of clinical features and treatment outcomes. J Neurooncol 153, 183–202 (2021). https://doi.org/10.1007/s11060-021-03757-z

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