Imaging of sacral tumours

Gerber, Sophie; Ollivier, L.; Leclère, J.; Vanel, D.; Missenard, G.; Brisse, H.; Pinieux, Gonzague de; Neuenschwander, S.

doi:10.1007/s00256-007-0413-4

Cited by 89 publications

(55 citation statements)

References 32 publications

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“…Distal sacral chordomas can be resected more easily and with less postoperative disability than proximal tumors [35]. However, in the surgical planning of a distal sacrectomy, preoperative staging of tumor infiltration into the gluteal muscles by MRI is crucial, and vast muscular resection is required for wide resection to reduce the risk of local recurrence [1,21,26,31,56]. Although we presumed resection at a lower level of the sacrum would relate to survivorship, we found no such difference with our relatively small cohorts.…”

Section: Discussioncontrasting

confidence: 49%

Surgical Margins and Local Control in Resection of Sacral Chordomas

Ruggieri

Angelini

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

166

152

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Background The treatment of choice in sacral chordoma is surgical resection, although the risk of local recurrence and metastasis remains high. The quality of surgical margins obtained at initial surgery is the primary factor to improve survival reducing the risk of local recurrence, but proximal sacral resections are associated with substantial perioperative morbidity. Questions/purposes We considered survivorship related to local recurrence in terms of surgical margins, level of resection, and previous surgery. Methods We retrospectively reviewed 56 patients with sacral chordomas treated with surgical resection. Thirtyseven were resected above S3 by a combined anterior and posterior approach and 19 at or below S3 by a posterior approach. Nine of these had had previous intralesional surgery elsewhere. The minimum followup was 3 years (mean, 9.5 years; range, 3-28 years). Results Overall survival was 97% at 5 years, 71% at 10 years, and 47% at 15 years. Survivorship to local recurrence was 65% at 5 years and 52% at 10 years. Thirty percent of patients developed metastases. Wide margins were associated with increased survivorship to local recurrence. We found no differences in local recurrence between wide and wide-contaminated margins (that is, if the tumor or its pseudocapsule was exposed intraoperatively, but further tissue was removed to achieve wide margins). Previous intralesional surgery was associated with an increased local recurrence rate. We observed no differences in the recurrence rate in resections above S3 or at and below S3. Conclusions Surgical margins affect the risk of local recurrence. Previous intralesional surgery was associated with a higher rate of local recurrence. Intraoperative contamination did not affect the risk of local recurrence when wide margins were subsequently attained.

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Section: Discussioncontrasting

confidence: 49%

Surgical Margins and Local Control in Resection of Sacral Chordomas

Ruggieri

Angelini

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

166

152

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“…MRI shows a low to intermediate signal intensity mass on T1-weighted and a high intensity mass lesion on T2-weighted and STIR images relative to skeletal muscle. 44 Follow-up imaging Osteosarcoma, with the exception of parosteal and low-grade central osteosarcoma, and Ewing's sarcoma are treated with chemotherapy prior to surgery. Radiotherapy may be added to the treatment regimen for Ewing's sarcoma.…”

Section: Chordomamentioning

confidence: 99%

(ii) The investigation and radiological features of primary bone malignancy

Kuchenbecker¹,

Davies²,

James³

2010

Orthopaedics and Trauma

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“…More accurate visualisation of the tumour may be obtained by means of magnetic resonance imaging (MRI), which remains the optimum method for assessing spinal metastatic disease [12][13][14][15]. This is used to visualise the relationship between the tumour, bone and soft tissues.…”

Section: Imagingmentioning

confidence: 99%

“…Therefore, this investigation is frequently used as part of a larger workup for systemic disease than as a stand-alone diagnostic tool. Generally, the presence of multifocal disease is suggestive of bone metastases, multiple myeloma, Paget's disease, infection and vascular tumours [12].…”

Section: Imagingmentioning

confidence: 99%

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Management of metastatic sacral tumours

et al. 2012

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Purpose Metastatic involvement of the sacrum is rare and there is a paucity of studies which deal with the management of these tumours since most papers refer to primary sacral tumours. This study aims to review the available literature in the management of sacral metastatic tumours as reflected in the current literature. Methods A systematic review of the English language literature was undertaken for relevant articles published over the last 11 years (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). The PubMed electronic database and reference lists of key articles were searched to identify relevant studies using the terms ''sacral metastases'' and ''metastatic sacral tumours''. Studies involving primary sacral tumours only were excluded. For the assessment of the level of evidence quality, the CEBM (Oxford Centre of Evidence Based Medicine) grading system was utilised. Results The initial search revealed 479 articles. After screening, 16 articles identified meeting our inclusion criteria [1 prospective cohort study on radiosurgery (level II); 2 case series (level III); 4 retrospective case series (level IV) and 9 case reports (level IV)]. Conclusion The mainstay of management for sacral metastatic tumours is palliation. Preoperative angioembolisation is shown to be of value in cases of highly vascularised tumours. Radiotherapy is used as the primary treatment in cases of inoperable tumours without spinal instability where pain relief and neurological improvement are attainable. Minimal invasive procedures such as sacroplasties were shown to offer immediate pain relief and improvement with ambulation, whereas more aggressive surgery, involving decompression and sacral reconstruction, is utilised mainly for the treatment of local advanced tumours which compromise the stability of the spine or threaten neurological status. Adjuvant cryosurgery and radiosurgery have demonstrated promising results (if no neurological compromise or instability) with local disease control.

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Imaging of sacral tumours

Cited by 89 publications

References 32 publications

Surgical Margins and Local Control in Resection of Sacral Chordomas

Surgical Margins and Local Control in Resection of Sacral Chordomas

(ii) The investigation and radiological features of primary bone malignancy

Management of metastatic sacral tumours

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