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Patients with rare sacral chordomas had 51% rate of localized tumor recurrence

Survival rates were 62% at 5 years and 26% at 10 years, which investigators said is comparable to previously reported results.

There is an increased risk of disease recurrence and reduced survival in patients with rare sacral chordomas when they have tumors with a diameter that exceeds 8 cm, muscular and sacroiliac joint infiltration, and inadequate resection margins, according to results of a study presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

“The patients with these aforementioned risk factors should undergo annual MRI surveillance,” Babar Kayani, MBBS, BSc, told Spine Surgery Today.

Kayani presented results of a retrospective study of 58 patients who underwent operative treatment for a primary sacral chordoma at the Bone Tumor Unit at Royal National Orthopaedic Hospital, in Stanmore, United Kingdom, between 1998 and 2013.

Patients’ mean age was 63 years. Mean follow-up was at 45.3 months.

Margins do matter

“In all cases the mean intent was curative with wide resection margins,” Kayani said.

The study showed a significant association between wide resection margins and reduced risk of tumor recurrence, as well as metastases, as compared to when intralesional or marginal resection margins were used.

The presence of dedifferentiated chordoma did not reach significance in the study, however, patients with this subtype of tumor trended toward having a greater incidence of tumor recurrence (70%) and metastases (50%) compared with patients with the conventional type of sacral chordoma, Kayani said.

MRI follow-up recommended

The surgical approach used did not affect outcomes, according to Kayani’s study, but surgeons typically used a posterior approach when they performed sacrectomy for tumors caudal to the S2 vertebra. When the tumor was at or cephalad to the S2 vertebra, they used a combined anterior-posterior approach.

Based on the results, there was a 51% rate of localized tumor recurrence and 32% of patients developed metastases.

“The use of adjuvant radiotherapy following sacrectomy was associated with an increased risk of localized recurrence and metastases, which is likely to reflect a selection bias in that this treatment was reserved for patients with high-risk disease,” Kayani said.

“Our survival rates at 5 [years] and 10 years were 62% and 26%, which is comparable with the data that is in the literature. Our mortality at 80 months was 50% and the poor survival was primarily due to the high risk of disease recurrence,” he said.

Kayani and colleagues support performing follow-up with T1 and T2 weighted MRI in this patient population because it allows the rare subtype of dedifferentiated chordomas to be better detected. – by Susan M. Rapp