Surgical treatment of primary mobile spine chordoma

Abstract

Background and Objectives Chordomas of the mobile spine (C1–L5) are rare malignant tumors. The purpose of this study was to review the outcome of surgical treatment for patients with primary mobile spine chordomas. Methods The oncologic outcomes and survival of 26 patients undergoing surgical resection for a primary mobile spine chordoma were assessed over a 25‐year period. The mean follow‐up was 12 ± 6 years. Results The 2‐, 5‐, and 10‐year disease‐free survivals were 95%, 61%, and 55%. The local recurrence‐free survival was improved in patients receiving en bloc resection with negative margins (83% vs. 35%, p = 0.02) and similar in patients receiving adjuvant radiation therapy (43% vs. 45%, p = 0.30) at 10 years. Debulking of the tumor (hazard ratio [HR] = 6.41, p = 0.01) and a local recurrence (HR = 9.52, p = 0.005) were associated with death due to disease. Complications occurred in 19 (73%) patients, leading to reoperation in 9 (35%) patients; this rate was similar in intralesional and en bloc procedures. Conclusion Surgical resection of mobile spine chordomas is associated with a high rate of complications; however, en bloc resection can provide a hope for cure and appears to confer better oncologic outcomes for these tumors without an increase in complications compared to lesser resections.

Outcomes of Recurrent Mobile Spine Chordomas

“…Although the complication rates were similar between these groups, those undergoing nonsurgical management had a higher rate of new neurologic deficits, suggesting opting for surgical management may help prevent neurologic decline in exchange for surgically related complications. The overall complication rate of those undergoing surgical resection of their recurrent chordoma was similar to the complication rate we previously reported after chordoma resection in the primary setting (76% vs. 73%), 19 and no complications were seen in the two patients undergoing EA resection.…”

“…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…”

“…We previously reported our experience in the surgical treatment of primary mobile spine chordomas. 19 When comparing the oncologic outcomes of this study to those with a primary chordoma, patients with a recurrent chordoma had a decreased disease-specific survival (44% vs. 61% at 5 years and 13% vs. 55% at 10 years) and local recurrence-free survival (11% vs. 58% at 5 years) with a similar metastatic-free survival (62% vs. 66% at 5 years). These outcomes are similar to those reported by Wang et al 22 when treating recurrent cervical chordomas where they found a 2-year recurrence-free survival of 12.5% and overall survival of 37.5%.…”

“…However, patients undergoing an Enneking appropriate (EA) resection (en bloc resection with negative margins on final pathology) 3,18 had improved local recurrence‐free survival, giving patients a hope for a cure without an increased complication profile. 19…”

Management of Chordoma of the Sacrum and Mobile Spine

“…In comparison, a single-institution study of 26 primary mobile spine chordoma patients reported on specific survival data, finding patients with R0 vs. R1 resection trended toward improved overall survival at 2 years (100% vs. 87%), 5 years (67% vs. 59%), and 10 years (67% vs. 35%) and local recurrence‐free survival at 2 years (100% vs. 67%), 5 years (83% vs. 52%), and 10 years (83% vs. 35%). They found similar survival data with patients receiving adjuvant RT and a complication rate of 73% 39 .…”