A lumbar chordoma treated with a wide resection

Bas, Teresa; Bas, Paloma; Prieto, Mireya; Ramose, V.; Bas, Jean-François Le; Espinosa, Carlos

doi:10.1007/bf02221451

Cited by 17 publications

(8 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A great amount of clinical data can be found in the literature supporting en bloc resection as the only treatment associated with long disease-free survival for chordomas [3,4,10,18,19,20,31]. Treatment of recurrences and intralesional excision cannot prevent local tumor recurrence even if survival can be quite long (with asymptomatic or, more frequently, symptomatic growing tumor).…”

Section: Introductionmentioning

confidence: 99%

En bloc resection of a C4 chordoma: surgical technique

et al. 2007

View full text Add to dashboard Cite

The prognosis of aggressive benign and low-grade malignant tumors in the spine as in the limbs, seems to be mostly related to the feasibility of en bloc resection, while in the treatment of high-grade malignant tumors the protocols of treatment include the combination of chemotherapy, radiation and surgery. Indications, criteria of feasibility and surgical technique are extensively reported for the thoracic and lumbar spine. In the cervical spine few cases are reported of resection, due not only to anatomical constraint, but also to the rarity of finding a tumor accomplishing the criteria of feasibility. A case of double-approach vertebrectomy finalized to remove en bloc the body of C4 for a stage IA chordoma is reported. The first stage was posterior, aiming to remove the posterior healthy elements by piecemeal technique. The anterior approach consisted of contemporary right and left prevascular presternocleidomastoid approaches The specimen was submitted for the histological study of the margins, which resulted tumor-free. This technical note is finalized to confirm that en bloc resection of the vertebral body through total vertebrectomy is feasible in the midcervical spine by double approaches, provided the tumor involves only layers B and C, maximum extension sectors 5-8.

show abstract

Section: Introductionmentioning

confidence: 99%

En bloc resection of a C4 chordoma: surgical technique

et al. 2007

View full text Add to dashboard Cite

show abstract

“…2,[11][12][13][14][15] Efforts to perform en bloc resections are warranted, even in the cervical spine 16 if the sensitivity of this tumor to palliative techniques, such as radiation, is only partial or a matter of indecision in the long-term. [17][18][19] The size of these tumors at diagnosis is sometimes so large that it prevents oncologically adequate treatments.…”

mentioning

confidence: 99%

Chordoma of the Mobile Spine: Fifty Years of Experience

Boriani¹,

Bandiera²,

Biagini³

et al. 2006

Spine

386

266

View full text Add to dashboard Cite

show abstract

“…1,13,18,27,29,32 Resection with tumor-free margins has already been validated for effectiveness in both local control and longterm prognosis for chordomas arising from the thoracic, lumbar, or sacral spine. 3,4,9,19,23,27,33 Hence, the ideal aim of en bloc cervical chordoma resecion is to achieve tumorfree margins, with wide margins being the goal for the pathology report and marginal margins being a nonideal but acceptable outcome. We found that, although marginal margins (attained in 56% of cases) were reported overall significantly more frequently than both wide (19%) and violated (25%) margins, this relationship was not conserved when the cases were stratified according to tumor location.…”

mentioning

confidence: 99%

Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience

Molina

Ames

Chou

et al. 2014

SPI

View full text Add to dashboard Cite

Object Chordomas involving the mobile spine are ideally managed via en bloc resection with reconstruction to optimize local control and possibly offer cure. In the cervical spine, local anatomy poses unique challenges, limiting the feasibility of aggressive resection. The authors present a multi-institutional series of 16 cases of cervical chordomas removed en bloc. Particular attention was paid to clinical outcome, complications, and recurrence. In addition, outcomes were assessed according to position of tumor at the C1–2 level versus the subaxial (SA) spine (C3–7). Methods The authors reviewed cases involving patients who underwent en bloc resection of cervical chordoma at 4 large spine centers. Patients were included if the lesion epicenter involved the C-1 to C-7 vertebral bodies. Demographic data and details of surgery, follow-up course, exposure to adjuvant therapy, and complications were obtained. Outcome was correlated with presence of tumor in C1–2 versus subaxial spine via a Student t-test. Results Sixteen patients were identified (mean age at presentation 55 ± 14 years). Seven cases (44%) cases involved C1–2, and 16 involved the subaxial spine. Median survival did not differ significantly different between the C1–2 (72 months) and SA (60 months) groups (p = 0.65). A combined (staged anteroposterior) approach was used in 81% of the cases. Use of the combined approach was significantly more common in treatment of subaxial than C1–2 tumors (100% vs 57%, p = 0.04). En bloc resection was attempted via an anterior approach in 6% of cases (C1–2: 14.3%; SA: 0%; p = 0.17) and a posterior approach in 13% of cases (C1–2: 29%; SA: 0%; p = 0.09). The most commonly reported margin classification was marginal (56% of cases), followed by violated (25%) and wide (19%). En bloc excision of subaxial tumors was significantly more likely to result in marginal margins than excision of C1–2 tumors (C1–2: 29%; SA: 78%; p = 0.03). C1–2 tumors were associated with significantly higher rates of postoperative complications (C1–2: 71%; SA: 22%; p = 0.03). Both local and distant tumor recurrence was greatest for C1–2 tumors (local C1–2: 29%; local SA: 11%; distant C1–2: 14%; distant SA: 0%). Statistical analysis of tumor recurrence based on tumor location was not possible due to the small number of cases. There was no between-groups difference in exposure to postoperative adjuvant radiotherapy. There was no difference in median survival between groups receiving proton beam radiotherapy or intensity-modulated radiotherapy versus no radiation therapy (p = 0.8). Conclusions Compared with en bloc resection of chordomas involving the subaxial cervical spine, en bloc resection of chordomas involving the upper cervical spine (C1–2) is associated with poorer outcomes, such as less favorable margins, higher rates of complications, and increased tumor recurrence. Data from this cohort do not support a statistically significant difference in survival for patients with C1–2 versus subaxial disease, but larger studies are needed to further study survival differences.

show abstract

A lumbar chordoma treated with a wide resection

Cited by 17 publications

References 26 publications

En bloc resection of a C4 chordoma: surgical technique

En bloc resection of a C4 chordoma: surgical technique

Chordoma of the Mobile Spine: Fifty Years of Experience

Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience

Contact Info

Product

Resources

About