Patients with sacral chordomas may benefit from annual follow up with MRI

NEW ORLEANS — There is an increased risk of disease recurrence and reduced survival in patients with rare sacral chordomas when they have tumors with a diameter greater than 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. Patients’ mean age was 63 years. Mean follow-up was at 45.3 months.

Although the presence of dedifferentiated chordoma did not reach significance in the study, patients with this subtype of tumor had greater incidence of tumor recurrence (70%) and metastases (50%) compared with patients with conventional sacral chordoma, he said.

The surgical approach used did not affect outcomes, according to Kayani, but surgeons typically used a posterior approach or, when the tumor was at or cephalad to the S2 vertebra, a combined anterior-posterior approach.

Use of adjuvant radiotherapy following sacrectomy was associated with an increased risk of localized recurrence and metastases, which likely reflected a selection bias since this treatment was reserved for patients with high-risk disease, according to Kayani.

“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, noting he and his 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 Rapp

Reference:

Kayani B. Paper #648. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.