Recurrent XXXX : Combining Surgery and Radiosurgery in One Effective Multimodal Treatment.

@entity1 @entity66 @entity146 @entity5 @entity1653 @entity1389
OBJECTIVE: Owing to their rarity and proteiform pathologic features, the clinical behavior of @entity1653 is not yet well characterized. Though the extent of resection is believed to be a key determinant of prognosis, limited data exist regarding optimal management of @entity1 with @entity66 . METHODS: In this 20-year retrospective case series, we reviewed the medical records of 46 @entity1 with recurrent @entity1389 (185 lesions, 89 of which were local, 78 marginal, and 18 distant recurrences); treatment was radiosurgery (n  = 60), surgery (n  = 56), or both (n  = 8). The median follow-up period was 53 months. Outcome measures were length of overall survival and disease-free intervals and prognostic factors for survival. RESULTS: Overall, the median progression-free survival was 26 months at the first recurrence and 100 months thereafter (the sum of the later intervals). Multivariate analysis showed that no treatment-related factors influenced prognosis, whereas recurrence at the skull base was a significant @entity5 -related factor limiting further treatment. Irrespective of treatment type, the recurrence-free interval was increasingly shorter during the clinical course, with a higher occurrence of marginal and distant lesions migrating to the midline and to the skull base. In sporadic cases, disease-free intervals were longer after wide craniotomy, @entity5 and dural resection with @entity5 -free margin. CONCLUSIONS: The disease-free interval was substantially similar after surgery and radiosurgery for treating @entity66 in @entity1 with @entity1653 . Surgery is the mainstay for prolonging survival, while radiosurgery can be an adjuvant strategy to gain time for clinical observation and @entity146 surgical treatment.
