Surgical Treatment of sacrococcygeal chordoma.

BACKGROUND: Sacrococcygeal chordomas are difficult to manage.
METHODS: The treatment results of 12 patients with sacral chordomas were analyzed. Four patients had local relapse before they were referred to our hospital: three patients previously underwent two surgeries, and one patient one surgery and irradiation (60 Gy). In this institute, 10 patients underwent surgery alone, and one had surgery plus postoperative irradiation. One patient underwent radiotherapy alone due to an inoperable lesion that reached to the L5 spine. For seven surviving patients, the average follow-up period was 50 months.
RESULTS: One of four patients with a marginal margin and one of two patients with a contaminated margin developed local relapse. Of five patients with intralesional margins, four patients developed local relapse and two had metastasis to the spine and lungs 36 and 15 months after surgery, respectively. One patient with irradiation alone had metastasis to the lungs 15 months after initiation of treatment. Three patients died due to progression of the disease, one of a heart problem and one of apoplexy. One of 10 patients with implantation of gentamycin beads after removal of tumor, developed infection.
CONCLUSIONS: For local control of sacral chordomas, an adequate surgical margin is important. Gentamycin beads may be effective to control postoperative infection of the dead space.