Sacral chordoma: management of a rare disease in a tertiary hospital

Housari, Gada; González, M.; Calero, Purificación; Beni, Rafael; Lobo, Eduardo

doi:10.1007/s12094-012-0919-7

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…The mean operative time in most previous reports were 5–10 h, and the mean blood losses were 3900–5200 ml. [ 17 20 29 33 34 ] Only sufficient experience with navigation can increase the safety of surgery, otherwise the operation time and related risk may be elevated.…”

Section: Discussionmentioning

confidence: 99%

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Computer Navigation-aided Resection of Sacral Chordomas

Yang

Chan

Zhang

et al. 2016

Chinese Medical Journal

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Background:Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas.Methods:Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35–84 years old). Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18–84 months).Results:Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7%) exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19–30).Conclusions:Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.

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Section: Discussionmentioning

confidence: 99%

“…Housari et al . [ 34 ] reported 13 patients with a mean follow-up of 4.5 years and all nine recurrences occurred within the first 2 years postoperatively. Although our follow-up was relatively short compared with previous reports, satisfactory resection margin and good local control were achieved during a period of time.…”

Section: Discussionmentioning

confidence: 99%

Computer Navigation-aided Resection of Sacral Chordomas

Yang

Chan

Zhang

et al. 2016

Chinese Medical Journal

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“…Chordoma is an uncommon malignant bone tumor of the axial skeleton; it is assumed to originate from residual embryonic notochord and accounts for approximately 1%‐4% of all skeletal tumors . Chordomas are chemoresistant and relatively radioresistant . Unfortunately, more than 40% of patients present with local recurrence, and metastases occur in 40%‐60% of patients during follow‐up.…”

Section: Introductionmentioning

confidence: 99%

“…1 Chordomas are chemoresistant and relatively radioresistant. [2][3][4] Unfortunately, more than 40% of patients present with local recurrence, and metastases occur in 40%-60% of patients during follow-up. There is currently no standard medical therapy for chordoma.…”

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confidence: 99%

Y‐box binding protein‐1 promotes tumorigenesis and progression via the epidermal growth factor receptor/AKT pathway in spinal chordoma

Chen

Lei

et al. 2018

Cancer Science

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Chordomas are rare bone tumors with a poor prognosis and no approved targeted therapy. Y‐box binding protein‐1 (YBX1) promotes tumor growth, invasion and drug resistance. However, the role of YBX1 in chordoma is unclear. In this study, we examined the expression of YBX1 using immunohistochemistry and found that YBX1 was significantly upregulated in 32 chordoma tissues compared to distant normal tissues. In addition, YBX1 upregulation was associated with surrounding tissue invasion, recurrence and poor prognosis. Biological function studies demonstrated that YBX1 promoted cell proliferation and invasion, accelerated G1/S phase transition, and inhibited apoptosis. Further investigation revealed that YBX1 enhanced epidermal growth factor receptor (EGFR) transcription by directly binding to its promoter in chordoma cells. YBX1 regulated protein expression of p‐EGFR, p‐AKT and its downstream target genes that influenced cell apoptosis, cell cycle transition and cell invasion. YBX1 activated the EGFR/AKT pathway in chordoma and YBX1‐induced elevated expression of key molecules in the EGFR/AKT pathway were downregulated by EGFR and AKT pathway inhibitors. These in vitro results were further confirmed by in vivo data. These data showed that YBX1 promoted tumorigenesis and progression in spinal chordoma via the EGFR/AKT pathway. YBX1 might serve as a prognostic and predictive biomarker, as well as a rational therapeutic target, for chordoma.

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“…Therefore, most of the local recurrences were associated with bone. Previous reports [7,17,18] have also shown most recurrences were located around the sacrum and other sites including the gluteus maximus and ischioanal fossa. Xie et al [16] assessed 30 patients with recurrent sacral chordomas and found that most recurrent tumors were located in sacrum (20 patients) and that some were located in the gluteus maximus (6 patients).…”

Section: Discussionmentioning

confidence: 88%

The clinical outcome of recurrent sacral chordoma with further surgical treatment

Yang

Liu

et al. 2018

Medicine

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Case series.To analyze the clinical results and related factors of further surgical treatment for recurrent sacral chordomas.Chordomas are rare primary malignant tumors with a high recurrence rate. The treatment of recurrent tumors is difficult and controversial. Contamination by previous operations and disturbed local anatomical structures may increase the risk of reoperation. Most previous studies have focused on the primary tumor; there are very few reports on the clinical diagnosis, treatment, and prognosis of recurrent sacral chordomas.Thirty-four patients with recurrent sacral chordomas from 1979 to 2014 were included in this study. The patients comprised 25 men and 9 women with an average age of 50.7 (24–75) years. The average time until recurrence was 19.4 (4–51) months postoperatively, and 85.3% of the recurrent tumors were located in bone. The patients had an average of 1.2 (1–3) recurrences before further operations were performed in our hospital. The mean maximum tumor diameter was 8.1 (4.6–12.0) cm. Thirty-one patients underwent further tumor resection in our hospital. The postoperative recurrence, metastasis, and survival results were followed and analyzed.The mean follow-up after surgical treatment of recurrence was 49.6 (12–144) months. Nine patients (37.5%) developed recurrence again after an average of 26.7 months. The 3-year and 5-year recurrence-free survival rate was 69.4% and 63.1%, respectively. Multivariate analysis showed that the tumor level within the sacrum (P = .001) and the surgical margin (P = .001) were significant recurrence-related factors. Four patients (16.7%) developed lung metastasis. Eighteen patients were alive at last follow-up. The 5-year and 10-year survival rate after surgical treatment of recurrence was 67.3% and 53.9%, respectively.Most recurrent tumors are located in bone, and a safe osteotomy margin is important. The surgical margin is the only controllable factor of further tumor recurrence. Some patients with recurrence achieve long survival and obtain a clinical benefit from repeated operations if complete resection is achieved.

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Sacral chordoma: management of a rare disease in a tertiary hospital

Abstract: In our experience, the best treatment is complete excision of the tumor with clear microscopic margins. When this is not possible, local recurrences increase and survival rate decreases.

Cited by 14 publications

References 12 publications

Computer Navigation-aided Resection of Sacral Chordomas

Computer Navigation-aided Resection of Sacral Chordomas

Y‐box binding protein‐1 promotes tumorigenesis and progression via the epidermal growth factor receptor/AKT pathway in spinal chordoma

The clinical outcome of recurrent sacral chordoma with further surgical treatment

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