Prognostic factors in surgical resection of sacral chordoma

Angelini, Andrea; Pala, Elisa; Calabrò, Teresa; Maraldi, Marco; Ruggieri, Pietro

doi:10.1002/jso.23987

Cited by 69 publications

(49 citation statements)

References 47 publications

(198 reference statements)

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“…The majority of local relapses (90%) occurred in the rst 5 years after primary therapy including heavy ion-based irradiation, resulting in a 5-year LC rate of 53%, which is in line with other retrospective studies [6,12,13]. In contrast to the frequent local recurrences, the distant metastasis rate in our analysis was relatively low (9%) compared to other retrospective studies (range 19 -40%) [4,[14][15][16].…”

Section: Discussionsupporting

confidence: 88%

High-dose carbon-ion based radiotherapy of primary and recurrent sacrococcygeal chordomas: Long-term clinical results of a single particle therapy center.

Bostel

Mattke

Nicolay

et al. 2020

Preprint

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BackgroundThis study aimed to analyze the oncological long-term results and late toxicity of carbon ion-based radiotherapy (RT) of patients with sacral chordoma and to identify potential prognostic factors for local control (LC) and overall survival (OS).MethodsA total of 68 patients with sacral chordoma treated at the Heidelberg Ion Beam Therapy Center were included in this study. Of these 52 patients (77%) received a primary RT and 16 patients (23%) received a RT in a recurrent situation. All patients were treated with carbon ion RT (CIRT), either in combination with photons (n = 22; 32%) or as a monotherapy (n = 46; 68%), with a median radiation dose of 66 Gy RBE (range 60 - 74 Gy). In 40 patients (59%), RT was performed in the postoperative situation. Postoperative care included regular MRI scans. Local progression was defined as an enlargement of the maximum tumor diameter by 10% or a new tumor growth within the planning target volume (PTV). LC and OS were determined using the Kaplan-Meier method. Furthermore, the relevance of various prognostic factors for LC and OS was assessed by univariate and multivariate analysis.ResultsThe median follow-up period was 60 months (range 1.3 – 97.4 months). The 5-year rates for LC, progression-free survival, metastasis-free survival and OS were 53%, 53%, 52% and 74%, respectively. Local recurrence was observed in 31 patients (46%), occurring after a median follow-up time of 25 months (range 2.5 – 73.1months). Only 10% of local recurrences occurred later than 5 years after RT. Statistical analysis showed thatRT in the relapse situation corresponded to inferior LC rates compared to the primary situation, while other factors such as the GTV, radiation dose (EQD2) and treatment approach (CIRT alone vs. CIRT combined with photons) were insignificant. For OS after RT, patient age and PTV size proved to be significant predictors.The incidence of late toxicity ≥ III° according to CTCAE v5.0 was 21%. Sacral insufficiency fractures occurred in 49% of patients (maximum III°: 16%) and were thus by far the most frequent late side effect in our analysis. Radiogenic damage to the peripheral nerves, intestinal tract and skin was observed in only 9% (≥ III°: 5%), 3% (all II°) and 9% (all I°) of patients.ConclusionOur analysis showed only moderate long-term LC rates after carbon ion-based RT, with sacral chordomas having a particularly poor prognosis in the recurrent situation. Therefore, future studies should evaluate the safety and effectiveness of further dose escalation and hypofractionation of RT in sacral chordoma and weight potential benefits of dose escalation against side effects.

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Section: Discussionsupporting

confidence: 88%

High-dose carbon-ion based radiotherapy of primary and recurrent sacrococcygeal chordomas: Long-term clinical results of a single particle therapy center.

Bostel

Mattke

Nicolay

et al. 2020

Preprint

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“…Surgical treatment of sacrococcygeal chordomas had resulted in a 5-year overall survival rate ranging from 50%-97%, [2][3][4][9][10][11][22][23][24][25][26][27][28][29][30][31] and a local recurrence rate with wide margins of 0%-60%. 2,4,22,24,25,27,30,31 Due to the high rates of local recurrence after surgery alone, radiotherapy has been used in addition to surgery to assist with local tumor control.…”

Section: Overall and Disease-specific Survivalmentioning

confidence: 99%

Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

Houdek

Rose

Hevesi

et al. 2019

Journal of Surgical Oncology

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Background We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. Methods A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow‐up of 7 ± 4 years. Eighty‐nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. Results The 10‐year disease‐free and disease‐specific survival was 58% and 72%, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.59‐2.17; P = 0.71), metastases (HR, 0.93; 95% CI, 0.45‐1.91; P = 0.85) or disease‐specific survival (HR, 0.96; 95% CI, 0.46‐2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95% CI, 0.20‐1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95% CI, 1.64‐4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95% CI, 1.88‐14.38; P < 0.001). Conclusions In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en‐bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.

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“…To date, few large series describing the management of sacral chordoma exist [1,42]. Moreover, prior studies have often focused on single, static 5-or 10-year overall survival or disease-free survival determined at the time of diagnosis [26,34,37].…”

Section: Introductionmentioning

confidence: 99%

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

Guo

Yang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Conditional survival is a measure of prognosis for patients who have already survived for a specific period of time; however, data on conditional survival after sacrectomy in patients with sacral chordoma are lacking. In addition, because sacral tumors are rare and heterogeneous, classifying them in a way that allows physicians to predict functional outcomes after sacrectomy remains a challenge. Questions/purposes (1) What is the overall survival and disease-free survival in patients treated by sacrectomy for chordoma? (2) What is the conditional survival probability and how do prognostic factors change over time in patients undergoing surgical resection for sacral chordoma? (3) What is the local recurrence rate after surgery, how was it treated, and what factors impact on local recurrence? (4) What is the postoperative motor, sensory, bowel, and bladder function by level of resection as determined by using a newly designed scoring method?Methods Between 2003 and 2012, our center treated 122 patients surgically for sacral chordoma. Of those, two died and five were lost before a minimum followup of 1 year was achieved, leaving 115 patients available for analysis in this retrospective study at a mean of 4.9 years (range, 1.3-10.8 years). Basically, single posterior or combined approaches were chosen based on the most cephalad extent of the tumor and resection level was normally at half or one sacral vertebrae above the tumor. The 5-year conditional survival rate was calculated based on Kaplan-Meier survival analysis. The effect of prognostic factors on conditional survival was also explored. A newly designed score method was proposed and adopted in the current study to critically evaluate the functional outcome after resection of the sacrum. Inter-and intraobserver reliability was tested by a preliminary study using kappa statistics and Spearman rank correlation coefficients. Significant interobserver (p\0.01) and intraobserver agreement (j[0.75) were found in nine items between each observer. Results The estimated 5-year overall survival rate was 81% (95% confidence interval [CI], 72%-90%) at diagnosis. The 5-year disease-free survival rate was 52% (95% CI, 43%-63%). The 5-year conditional overall survival decreased with each additional year in the first 4 years (81% at diagnosis versus 60% at the fourth year, p \ 0.0001) and increased slightly in the fifth year. Patients with adequate surgical margins displayed a higher 5-year survival than those with an inadequate margin (86% [95% CI, 76%-95%] versus 67% [95% CI, 48%-85%], p = 0.01) at diagnosis. Conditional survival estimates for patients who received operations elsewhere were lower than that of newly diagnosed patients treated by us at diagnosis (64% [95% CI, 46%-83%] versus 90% [95% CI, 82%-99%], p = 0.012), but with the numbers we had, we could not detect a difference in conditional survival between those treated elsewhere first compared with those initially treated by us at 5 years. The proposed score system for function evaluation was a...

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Prognostic factors in surgical resection of sacral chordoma

Abstract: The most prominent adverse factor for LR was previous intralesional surgery. LR rate was related with inadequate margins and tumor volume.

Cited by 69 publications

References 47 publications

High-dose carbon-ion based radiotherapy of primary and recurrent sacrococcygeal chordomas: Long-term clinical results of a single particle therapy center.

High-dose carbon-ion based radiotherapy of primary and recurrent sacrococcygeal chordomas: Long-term clinical results of a single particle therapy center.

Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

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