Outcomes of Recurrent Mobile Spine Chordomas

Abstract

Introduction: Chordomas of the mobile spine are rare malignant tumors. The purpose of this study was to review the outcomes of treatment for patients with recurrent mobile spine chordomas. Methods: The oncologic outcomes and survival of 30 patients undergoing treatment of a recurrent mobile spine chordoma were assessed over a 24-year period. The mean follow-up was 3.5 years. Results: In patients presenting with a recurrent mobile spine chordoma, the mean 2-and 5-year overall survival was 73% and 39%, respectively. Enneking appropriate resection trended toward improved overall survival at 5 years (100% vs. 32%, P = 0.24). Those undergoing surgical resection for recurrence had improved metastatic-free survival (hazard ratio 0.29, CI 0.08 to 0.99, P = 0.05). Positive margins were found to be a risk factor of further local recurrence (hazard ratio 7.92, CI 1.02 to 61.49, P = 0.04). Those undergoing nonsurgical management trended toward having an increase in new neurologic deficits (P = 0.09), however, there was no difference in overall complications based on treatment type (P = 0.13). Conclusion: Recurrent mobile spine chordoma portends a poor prognosis with an overall survival of less than 40% at 5 years. Surgical resection may help prevent new neurologic deficits and tumor metastasis while en bloc excision with negative surgical margins is associated with improved local recurrence-free survival. Chordomas are primary bone tumors most commonly presenting in the axial skeleton. The most common locations include the skull base, sacrum, and mobile spine (C1-L5). [1][2][3][4] These rare tumors are locally aggressive and have the capacity to metastasize leading to notable morbidity and mortality with either surgical or nonsurgical treatments. Given the relative scarcity of these tumors, most of the previous literature has combined primary and recurrent chordomas into a single cohort and included chordomas in all locations. 3,[5][6][7][8][9][10][11][12][13][14][15][16][17] These studies demonstrated poor overall local recurrence-free survival and overall survival, but en bloc and gross total excision tend to improve survival rates. 3,4,6,17,18 Our group previously reported the outcomes of a focused series of primary mobile spine chordomas treated surgically. 19 This study demonstrated the

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“…Spinal bone tumors remain a challenging clinical entity. Kolz et al reviewed a series of patients undergoing treatment for chordomas in the mobile spine and found a poor overall survival of 39% at 5 years 28 . However, the authors found that surgical resection was beneficial in preventing new neurologic deficits.…”