Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Hanna, Sammy A.; Aston, Will; Briggs, Timothy; Cannon, Stephen R.; Saifuddin, Asif

doi:10.1007/s11999-008-0356-7

Cited by 108 publications

(86 citation statements)

References 34 publications

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“…Hanna et al 16 suggested infiltration of the musculature adjacent to the sacrum and/or involvement of the sacroiliac joints increases the tendency of local recurrence, even after apparently successful en bloc resection of the tumor. All patients with invasion of the surrounding muscle had The role of traditional radiation remains controversial because chordomas are not very radiosensitive.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients

et al. 2009

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Study design: Retrospective study. Objectives: To investigate prognostic factors of sacral chordomas and provide theoretical foundation for an improvement of continuous disease-free survival (CDFS). Methods: Thirty-six patients underwent initial operation for sacral chordoma between 1992 and 2007. Data regarding age, gender, tumor size, tumor location, and type of surgery, surgical margins, surrounding muscle invasion, radiation therapy, and recurrences were reviewed and analyzed statistically. Results: The average duration of follow-up was 74.4 months (range, 16-182 months). Sixteen patients developed local recurrences at the time of final follow-up. The average recurrence time was 30 months (range, 3-84 months). The 5-year and 10-year actuarial CDFS were 59.5 and 42%, respectively. CDFS was found statistically longer in patients whose tumor highest level at or below S3 compared with above S3 (P ¼ 0.047). Patients who had invasion into the surrounding muscle had a shorter CDFS than those without surrounding muscle invasion (P ¼ 0.014). Statistic analysis showed that the type of surgery was the most valuable indicator of CDFS (P ¼ 0.001). The local recurrence rate was statistically higher when an inadequate margin has been achieved (P ¼ 0.021). The Cox multivariate regression analysis showed that surrounding muscle invasion (P ¼ 0.024) was an independent adverse prognostic factor for CDFS, whereas incomplete excision (P ¼ 0.056) achieved borderline significance. Conclusions: The higher level of tumor involvement, invasion into the surrounding muscle, incomplete excision, and inadequate surgical margins are poor prognostic factors. Resecting the tumor completely with wide surgical margins may provide a better prognosis for these patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients

et al. 2009

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“…Bergh et al [3] reported a 37% local recurrence rate at a median of 8 years of followup. Baratti et al [2], Hulen et al [24], and Hanna et al [20] reported local recurrence rates of 54%, 56%, and 60%, respectively, at mean followups of 5.9, 5.5, and 4.4 years, respectively, after wide resection. Fuchs et al [13] reported an excellent recurrence rate of 5% in 21 patients who all received wide resection.…”

Section: Figmentioning

confidence: 98%

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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“…Its minimal response to chemo-and radiotherapy [6,13] makes surgery the treatment of choice [14,47]. Local recurrence rates range from 43% to 85% [2,4,5,20,26,29,31,56,57] depending on the surgical margins obtained at initial Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.…”

Section: Introductionmentioning

confidence: 99%

Surgical Margins and Local Control in Resection of Sacral Chordomas

Ruggieri

Angelini

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

165

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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Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Cited by 108 publications

References 34 publications

Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients

Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients

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

Surgical Margins and Local Control in Resection of Sacral Chordomas

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