BACKGROUND AND OBJECTIVES: The best treatment of sacral chordoma is surgical resection, nowadays associated with optimized radiation therapy. We analysed 1) the oncologic outcome in a large series; 2) the effect of previous intralesional surgery, resection level, tumor volume and margins on survivorship to local recurrence (LR) and 3) the complication rate. METHODS: We reviewed 71 patients with sacral chordomas. Forty-eight resections were proximal to S3. Mean tumor volume was 535 cm3. Eleven received previous intralesional surgery elsewhere. Margins were wide in 44 resections, wide-contaminated in 11, marginal in 9 and intralesional in 7. RESULTS: Overall survival was 92%, 65% and 44% at 5, 10 and 15 years. At a mean of 9.5 years 37 were NED (54.4%), 23 died with disease (33.8%) and 8 were alive with disease (11.7%). Relapses included 15 LRs, 6 distant metastases, 17 both. LR rate was significantly higher in patients with previous surgery (p=0.0217), with inadequate margins (p= 0.0339) and large tumors(p<0.01), whereas resection level was not significant. Multivariate analysis confirmed the role of tumor volume. Complication rate was high (80.9%) with an infection rate of 41.2%. CONCLUSIONS: The most prominent adverse factor for LR was previous intralesional surgery. LR rate was related with inadequate margins and tumor volume.
BACKGROUND AND OBJECTIVES: The best treatment of sacral chordoma is surgical resection, nowadays associated with optimized radiation therapy. We analysed 1) the oncologic outcome in a large series; 2) the effect of previous intralesional surgery, resection level, tumor volume and margins on survivorship to local recurrence (LR) and 3) the complication rate. METHODS: We reviewed 71 patients with sacral chordomas. Forty-eight resections were proximal to S3. Mean tumor volume was 535 cm3. Eleven received previous intralesional surgery elsewhere. Margins were wide in 44 resections, wide-contaminated in 11, marginal in 9 and intralesional in 7. RESULTS: Overall survival was 92%, 65% and 44% at 5, 10 and 15 years. At a mean of 9.5 years 37 were NED (54.4%), 23 died with disease (33.8%) and 8 were alive with disease (11.7%). Relapses included 15 LRs, 6 distant metastases, 17 both. LR rate was significantly higher in patients with previous surgery (p=0.0217), with inadequate margins (p= 0.0339) and large tumors(p<0.01), whereas resection level was not significant. Multivariate analysis confirmed the role of tumor volume. Complication rate was high (80.9%) with an infection rate of 41.2%. CONCLUSIONS: The most prominent adverse factor for LR was previous intralesional surgery. LR rate was related with inadequate margins and tumor volume.
Authors: Matthew T Houdek; Peter S Rose; Mario Hevesi; Joseph H Schwab; Anthony M Griffin; John H Healey; Ivy A Petersen; Thomas F DeLaney; Peter W Chung; Michael J Yaszemski; Jay S Wunder; Francis J Hornicek; Patrick J Boland; Franklin H Sim; Peter C Ferguson Journal: J Surg Oncol Date: 2019-02-07 Impact factor: 3.454
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Authors: Matthew R Claxton; Matthew B Shirley; Joshua D Johnson; Kevin I Perry; Peter S Rose; Matthew T Houdek Journal: In Vivo Date: 2020 Sep-Oct Impact factor: 2.155
Authors: Matthew T Houdek; Mario Hevesi; Joseph H Schwab; Michael J Yaszemski; Anthony M Griffin; John H Healey; Peter C Ferguson; Francis J Hornicek; Patrick J Boland; Franklin H Sim; Peter S Rose; Jay S Wunder Journal: J Surg Oncol Date: 2019-11-22 Impact factor: 2.885
Authors: Scott L Zuckerman; Sun-Ho Lee; George J Chang; Garrett L Walsh; Reza J Mehran; Ziya L Gokaslan; Ganesh Rao; Claudio E Tatsui; Laurence D Rhines Journal: Global Spine J Date: 2021-06