Current treatment strategy for newly diagnosed chordoma of the mobile spine and sacrum: results of an international survey

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The purpose of this study was to investigate the spectrum of current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A survey on the treatment of spinal chordoma was distributed electronically to members of the AOSpine Knowledge Forum Tumor, including neurosurgeons, orthopedic surgeons, and radiation oncologists from North America, South America, Europe, Asia, and Australia. Survey participants were pre-identified clinicians from centers with expertise in the treatment of spinal tumors. The suvey responses were analyzed using descriptive statistics.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Thirty-nine of 43 (91%) participants completed the survey. Most (80%) indicated that they favor en bloc resection without preoperative neoadjuvant radiation therapy (RT) when en bloc resection is feasible with acceptable morbidity. The main area of disagreement was with the role of postoperative RT, where 41% preferred giving RT only if positive margins were achieved and 38% preferred giving RT irrespective of margin status. When en bloc resection would result in significant morbidity, 33% preferred planned intralesional resection followed by RT, and 33% preferred giving neoadjuvant RT prior to surgery. In total, 8 treatment protocols were identified: 3 in which en bloc resection is feasible with acceptable morbidity and 5 in which en bloc resection would result in significant morbidity.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The results confirm that there is treatment variability across centers worldwide for managing newly diagnosed chordoma of the mobile spine and sacrum. This information will be used to design an international prospective cohort study to determine the most appropriate treatment strategy for patients with spinal chordoma.</jats:p></jats:sec>

Primary Bone Tumor of the Spine—An Evolving Field: What a General Spine Surgeon Should Know

“…37 A recent survey by the AOKFT revealed large variations across some of the world's most experienced cancer centers in the use of radiation modalities in the setting of newly diagnosed spinal chordomas. 38 For tumors with which en bloc resection is feasible with acceptable morbidity, some centers are giving neoadjuvant radiation as a standard of care, other centers are administering routine postoperative radiation regardless of the surgical margins, and some centers are not pursuing any radiation treatment when wide/marginal margins are obtained. On the other hand, when en bloc resection would result in significant morbidity, some centers rely more heavily on neoadjuvant and adjuvant therapies with variation in the surgical procedure.…”

Spondylectomy in the Treatment of Neoplastic Spinal Lesions – A Retrospective Outcome Analysis of 582 Patients Using a Patient-Level Meta-Analysis

“…As seen in (Table 3), the most frequent lesions undergoing TES were sarcoma, metastasis, chordoma, and plasmacytoma. The literature clearly shows that TES results in superior oncologic outcome in terms of progression-free and overall survival for the following entities: sarcoma, GCT, chordoma and ABC [18][19][20][21][22][23]. In a recent consensus statement by the Chordoma Global Consensus group, it was agreed that extralesional resection is the treatment of choice for localized chordoma whenever feasible [1].…”

Surgical Consideration for Patients with Repeatedly Recurrent Spinal Chordoma: A Systematic Analysis of Prognostic Factors and Quality of Life

“…With the spinal complex anatomic structure and high potential of recurrence, the management of recurrent spinal chordoma was extremely big challenge for surgeons [16]. As for RRSC, how to decrease the risk of recurrence and prolong the OS was a tough issue due to its locally aggressive behavior and its resistance to adjuvant therapies [17,18]. Notably, it is the rst time to take NOR and FSI into consideration of prognosis of patients with RRSC.…”

“…Subtype analysis was described in Table 4. Subtotal resection, subtotal resection + RT, total piecemeal resection, total piecemeal resection + RT, and En bloc resection were used in 15,12,16,18, and 4 cases, respectively. Statistical analysis revealed that treatment method could make a signi cant difference in RFS (P < 0.001) and OS (P = 0.006), and patients undertaken total piecemeal resection and en bloc resection had longer RFS and OS.…”