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Tena Suck ML, Villanueva-Castro E, Munuzuri-Camacho MA, Hernández Reséndiz R, Juárez-Cruz SI, Garcia-Diaz OC, Castro-Ibanez JA. Degenerative Atypia in Clival Chordoma: Two Case Reports. Cureus 2024; 16:e66197. [PMID: 39233954 PMCID: PMC11373669 DOI: 10.7759/cureus.66197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
In this study, we report surgical management combined with radiotherapy in two patients with typical chordoma. Different types of radiation have varied effects on chordomas when they are radiated. Classical cases display cellular atypia and fibrosis following irradiation, while necrosis and fibrosclerosis are observed after carbon ion therapy, implying that it is possible to control the tumor more effectively using carbon ion therapy with minimal side effects.
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Affiliation(s)
- Martha Lilia Tena Suck
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | | | - Samuel Ismael Juárez-Cruz
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Jose Alfredo Castro-Ibanez
- Department of Neuroimaging, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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2
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Abualkhair KA, Sharif AF, Eid H, ElToukhy AG, Ezzat M, Taha MM. Unusual Presentation of Thoracic Chordoma with Spinal Epidural Hematoma: A Rare Case Report and PRISMA-Driven Systematic Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241266099. [PMID: 39081345 PMCID: PMC11287744 DOI: 10.1177/11795476241266099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/12/2024] [Indexed: 08/02/2024]
Abstract
A chordoma is a slow growing, locally invasive, low-grade tumor belonging to the sarcoma family. It mainly affects the sacrum and skull base. We present a case of thoracic chordoma initially presented with epidural hematoma (EDH), which is a rare clinical entity. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes the clinical characteristics and outcome of thoracic chordoma. Our case involves a 60-year-old male who, despite no history of trauma, presented with acute paraparesis. An epidural hematoma was identified at T6 level, leading to a surgical intervention involving T4-6 laminectomy and fixation. Six months subsequent to surgery, the patient experienced progressive lower limb weakness and spasticity. Computed tomography (CT) exhibited erosion of T6 and an associated aggressive mass. Magnetic resonance imaging (MRI) revealed a large heterogenous soft tissue mass arising from the vertebral body and right pedicle of D6, protruding in the epidural space and compressing the spinal cord focally at this level. The mass measured approximately 5 × 4 × 3.5 cm. Magnetic resonance myelography indicated a filling defect at T5-6 level, confirming the intraspinal location of the soft tissue lesion. Complete excision of the mass confirmed the diagnosis of thoracic chordoma. Postoperative follow-up demonstrated notable improvement in the lower limb spasticity and paraparesis, and the patient started adjuvant radiotherapy. This case underscores the importance of maintaining a high index of suspicion when evaluating presentations resembling EDH.
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Affiliation(s)
| | - Asmaa F. Sharif
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta university, Egypt
| | - Hadeel Eid
- Department of Diagnostic Imaging, Menoufia University Hospitals, Menoufia, Egypt
| | - Ahmed G ElToukhy
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Ezzat
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud M Taha
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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3
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He J, Bi X. Automatic classification of spinal osteosarcoma and giant cell tumor of bone using optimized DenseNet. J Bone Oncol 2024; 46:100606. [PMID: 38778836 PMCID: PMC11109027 DOI: 10.1016/j.jbo.2024.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study aims to explore an optimized deep-learning model for automatically classifying spinal osteosarcoma and giant cell tumors. In particular, it aims to provide a reliable method for distinguishing between these challenging diagnoses in medical imaging. Methods This research employs an optimized DenseNet model with a self-attention mechanism to enhance feature extraction capabilities and reduce misclassification in differentiating spinal osteosarcoma and giant cell tumors. The model utilizes multi-scale feature map extraction for improved classification accuracy. The paper delves into the practical use of Gradient-weighted Class Activation Mapping (Grad-CAM) for enhancing medical image classification, specifically focusing on its application in diagnosing spinal osteosarcoma and giant cell tumors. The results demonstrate that the implementation of Grad-CAM visualization techniques has improved the performance of the deep learning model, resulting in an overall accuracy of 85.61%. Visualizations of images for these medical conditions using Grad-CAM, with corresponding class activation maps that indicate the tumor regions where the model focuses during predictions. Results The model achieves an overall accuracy of 80% or higher, with sensitivity exceeding 80% and specificity surpassing 80%. The average area under the curve AUC for spinal osteosarcoma and giant cell tumors is 0.814 and 0.882, respectively. The model significantly supports orthopedics physicians in developing treatment and care plans. Conclusion The DenseNet-based automatic classification model accurately distinguishes spinal osteosarcoma from giant cell tumors. This study contributes to medical image analysis, providing a valuable tool for clinicians in accurate diagnostic classification. Future efforts will focus on expanding the dataset and refining the algorithm to enhance the model's applicability in diverse clinical settings.
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Affiliation(s)
- Jingteng He
- General Hospital of Northern Theatre Command, Shenyang, Liaoning 110016, China
| | - Xiaojun Bi
- General Hospital of Northern Theatre Command, Shenyang, Liaoning 110016, China
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Ioakeim-Ioannidou M, Rose M, Chen YL, MacDonald SM. The Use of Proton and Carbon Ion Radiation Therapy for Sarcomas. Semin Radiat Oncol 2024; 34:207-217. [PMID: 38508785 DOI: 10.1016/j.semradonc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The unique physical and biological characteristics of proton and carbon ions allow for improved sparing of normal tissues, decreased integral dose to the body, and increased biological effect through high linear energy transfer. These properties are particularly useful for sarcomas given their histology, wide array of locations, and age of diagnosis. This review summarizes the literature and describes the clinical situations in which these heavy particles have advantages for treating sarcomas.
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Affiliation(s)
| | - Melanie Rose
- Department of Radiation Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
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5
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Alsubaie H, Aldoseri R, Alshehabi M, Nasser M. Nasopharyngeal Chordoma: A Case Report. Cureus 2024; 16:e58636. [PMID: 38644942 PMCID: PMC11032088 DOI: 10.7759/cureus.58636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 04/23/2024] Open
Abstract
Chordoma is a rare malignant neoplasm arising from remnants of primitive notochord. The most common location for chordoma is in the sacrum. This case presents a 10-year-old medically free male who came to the ENT clinic with the impression of adenoid hypertrophy. After further investigations, including imaging and biopsy, it was found to be a nasopharyngeal chordoma. Our aim, in this case, is to increase the suspension of differential diagnosis of nasopharyngeal masses other than adenoid hypertrophy. In addition, it highlights the importance of imaging in the evaluation of nasopharyngeal masses.
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Affiliation(s)
| | | | | | - Mai Nasser
- Otolaryngology & Head and Neck Surgery, The Royal Medical Services, Riffa, BHR
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Liu J, Hu P, Liu Z, Wei F. Complications and local recurrence of chondrosarcoma and chordoma treated by total tumor resection in thoracic and lumbar spine. BMC Musculoskelet Disord 2024; 25:237. [PMID: 38532352 DOI: 10.1186/s12891-024-07353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND En bloc resection of spinal tumors is challenging and associated with a high incidence of complications; however, it offers the potential to reduce the risk of recurrence when a wide margin is achieved. This research aims to investigate the safety and efficacy of en bloc resection in treating thoracic and lumbar chondrosarcoma/chordoma. METHODS Data from patients diagnosed with chondrosarcoma and chordoma in the thoracic or lumbar region, who underwent total en bloc or piecemeal resection at our institution over a 7-year period, were collected and regularly followed up. The study analyzed overall perioperative complications and compared differences in complications and local tumor recurrence between the two surgical methods. RESULTS Seventeen patients were included, comprising 12 with chondrosarcoma and 5 with chordoma. Among them, 5 cases underwent intralesional piecemeal resection, while the remaining 12 underwent planned en bloc resection. The average surgical time was 684 min (sd = 287), and the mean estimated blood loss was 2300 ml (sd = 1599). Thirty-five complications were recorded, with an average of 2.06 perioperative complications per patient. 82% of patients (14/17) experienced at least one perioperative complication, and major complications occurred in 64.7% (11/17). Five patients had local recurrence during the follow-up, with a mean recurrence time of 16.2 months (sd = 7.2) and a median recurrence time of 20 months (IQR = 12.5). Hospital stays, operation time, blood loss, and complication rates did not significantly differ between the two surgical methods. The local recurrence rate after en bloc resection was lower than piecemeal resection, although not statistically significant (P = 0.067). CONCLUSIONS The complication rates between the two surgical procedures were similar. Considering safety and local tumor control, en bloc resection is recommended as the primary choice for patients with chondrosarcoma/chordoma in the thoracic and lumbar regions who are eligible for this treatment.
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Affiliation(s)
- Jiacheng Liu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Panpan Hu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Zhongjun Liu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Feng Wei
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
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Tavares Junior MCM, Morale V, Soares LDS, Teixeira WGJ, Narazaki DK. Parasagittal resection of multilevel cervical chordoma with autograft duraplasty and unilateral vertebral artery ligation: A case report and literature review. Radiol Case Rep 2024; 19:1181-1189. [PMID: 38259708 PMCID: PMC10801135 DOI: 10.1016/j.radcr.2023.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Chordomas are rare tumors and the recommended course of treatment typically entails surgical resection, which presents significant challenges owing to the anatomical location commonly involved and the inherent resistance of these lesions to radiation and chemotherapy. This case report details the experience of a 61-year-old male who underwent a parasagittal resection spanning from C1 to C4. A durotomy was executed to enable en bloc excision of the tumor. Subsequently, a duraplasty procedure was implemented, utilizing autologous muscle fascia grafting. A comprehensive analysis of the pertinent literature was conducted to underscore the key clinical aspects and outcomes related to this topic.
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Affiliation(s)
| | - Victor Morale
- Cancer Institute of Sao Paulo State – Oncologic Orthopedic Spinal Surgery Division, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucas de Sousa Soares
- Cancer Institute of Sao Paulo State – Oncologic Orthopedic Spinal Surgery Division, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Douglas Kenji Narazaki
- Cancer Institute of Sao Paulo State – Oncologic Orthopedic Spinal Surgery Division, University of Sao Paulo, Sao Paulo, Brazil
- DWO Medicos Associados, Sao Paulo, Brazil
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Pham J, Shaaya E, Rhee B, Kimata A, Ozcan EE, Pham KM, Niu T, Sullivan P, Gokaslan ZL. Gross total resection and survival outcomes in elderly patients with spinal chordoma: a SEER-based analysis. Front Oncol 2024; 13:1327330. [PMID: 38352297 PMCID: PMC10862492 DOI: 10.3389/fonc.2023.1327330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Objective The association between aggressive resection and improved survival for adult spinal chordoma patients has not been well characterized in the geriatric population. Thus, the present study aimed to elucidate the relationship between gross total resection (GTR) and survival outcomes for patients across different age groups. Methods The authors isolated all adult patients diagnosed with spinal chordoma from the 2000-2019 Surveillance, Epidemiology, and End Results database and divided patients into three surgical subgroups: no surgery, subtotal resection (STR), and GTR. Kaplan-Meier curves with a log-rank test were used to discern differences in overall survival (OS) between surgical subgroups. Univariate and multivariate analyses were used to identify prognostic factors of mortality. Results There were 771 eligible patients: 227 (29.4%) received no surgery, 267 (34.6%) received STR, and 277 (35.9%) received GTR. Patients receiving no surgery had the lowest 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months). After stratifying patients by age, our multivariate analysis demonstrated that patients receiving GTR aged 40-59 (HR=0.26, CI=0.12-0.55, p<0.001), 60-79 (HR=0.51, CI=0.32-0.82, p=0.005), and 80-99 (HR=0.14, CI=0.05-0.37, p<0.001) had a lower risk of mortality compared to patients undergoing no surgery. The frequency of receiving GTR also decreased as a function of age (16.4% [80-99 years] vs. 43.2% [20-39 years]; p<0.001), but the frequency of receiving radiotherapy was comparable across all age groups (48.3% [80-99 years] vs. 45.5% [20-39 years]; p=0.762). Conclusion GTR is associated with improved survival for middle-aged and elderly patients with spinal chordoma. Therefore, patients should not be excluded from aggressive resection on the basis of age alone. Rather, the decision to pursue surgery should be decided on an individual basis.
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Affiliation(s)
- John Pham
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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Huo X, Wang K, Yao B, Song L, Li Z, He W, Li Y, Ma J, Wang L, Wu Z. Function and regulation of miR-186-5p, miR-125b-5p and miR-1260a in chordoma. BMC Cancer 2023; 23:1152. [PMID: 38012562 PMCID: PMC10680222 DOI: 10.1186/s12885-023-11238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The function and regulation of miRNAs in progression of chordoma were unclear. METHODS Five miRNAs were identified by the machine learning method from the miRNA expression array. CCk-8 assay, EDU assay, wound healing migration assay, and trans-well assay were used to reveal the effect of the miRNAs in chordoma cell lines. Moreover, bioinformation analysis and the mRNA expression array between the primary chordomas and recurrent chordomas were used to find the target protein genes of miRNAs. Furthermore, qRT-PCR and luciferase reporter assay were used to verify the result. RESULTS miR-186-5p, miR-30c-5p, miR-151b, and miR-125b-5p could inhibit proliferation, migration, and invasion of chordoma while miR-1260a enhances proliferation, migration, and invasion of chordoma. Recurrent chordoma has a worse disease-free outcome than the primary chordoma patients. AMOT, NPTX1, RYR3, and P2RX5 were the target protein mRNAs of miR-186-5p; NPTX1 was the target protein mRNAs of miR-125b-5p; and AMOT and TNFSF14 were the target protein mRNAs of miR-1260a. CONCLUSIONS miR-186-5p, miR-125b-5p, miR-1260a, and their target protein mRNAs including AMOT, NPTX1, RYR3, P2RX5, TNFSF14 may be the basement of chordoma research.
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Affiliation(s)
- Xulei Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, 100070, China
| | - Ke Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, 100070, China.
| | - Bohan Yao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, 100070, China
| | - Lairong Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, 100070, China
| | - Zirun Li
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wenyan He
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yiming Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, TianJin, China
| | - Junpeng Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, 100070, China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, 100070, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxilu 119, Fengtai District, Beijing, 100070, China.
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Martín Benlloch A, Bolós Ten L, Morales Codina AM. [Translated article] Vertebral metastases. En bloc treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S560-S575. [PMID: 37774916 DOI: 10.1016/j.recot.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
En bloc resection of vertebral metastases has been the subject of study in medical literature due to its impact on patients' quality of life and effectiveness in local disease control. This bibliographic analysis examines the findings and perspectives of published studies concerning en bloc resection of oligometastases in the spine. The technique, which involves the complete removal of the tumour along with a portion of the surrounding bone, has been shown to improve local tumour control, reduce recurrence, and potentially prolong patient survival compared to conventional decompression and stabilisation techniques. However, en bloc resection also presents risks and complications, such as surgical morbidity and extended recovery time. Appropriate patient selection, preoperative planning, and a multidisciplinary approach are essential to optimise outcomes. As new techniques and advances in adjuvant treatment develop, en bloc resection of oligometastases in the spine remains an area of interest in oncological research.
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Affiliation(s)
- A Martín Benlloch
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, Spain; Departamento de Cirugía, Universidad de Valencia, Valencia, Spain.
| | - L Bolós Ten
- Unidad de Columna A. Martín, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain
| | - A M Morales Codina
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, Spain
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Martín Benlloch A, Bolós Ten L, Morales Codina AM. Vertebral metastases. En bloc treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:560-575. [PMID: 37689353 DOI: 10.1016/j.recot.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023] Open
Abstract
En bloc resection of vertebral metastases has been the subject of study in medical literature due to its impact on patients' quality of life and effectiveness in local disease control. This bibliographic analysis examines the findings and perspectives of published studies concerning en bloc resection of oligometastases in the spine. The technique, which involves the complete removal of the tumour along with a portion of the surrounding bone, has been shown to improve local tumour control, reduce recurrence, and potentially prolong patient survival compared to conventional decompression and stabilization techniques. However, en bloc resection also presents risks and complications, such as surgical morbidity and extended recovery time. Appropriate patient selection, preoperative planning, and a multidisciplinary approach are essential to optimize outcomes. As new techniques and advances in adjuvant treatment develop, en bloc resection of oligometastases in the spine remains an area of interest in oncological research.
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Affiliation(s)
- A Martín Benlloch
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, España; Departamento de Cirugía, Universidad de Valencia, Valencia, España.
| | - L Bolós Ten
- Unidad de Columna A. Martín, Hospital Vithas Valencia 9 de Octubre, Valencia, España
| | - A M Morales Codina
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, España
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Huo X, Ma S, Wang C, Song L, Yao B, Zhu S, Li P, Wang L, Wu Z, Wang K. Unravelling the role of immune cells and FN1 in the recurrence and therapeutic process of skull base chordoma. Clin Transl Med 2023; 13:e1429. [PMID: 37784253 PMCID: PMC10545891 DOI: 10.1002/ctm2.1429] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/23/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Skull base chordoma is a rare and aggressive tumour of the bone that has a high likelihood of recurrence. The fundamental differences in single cells between primary and recurrent lesions remain poorly understood, impeding development of effective treatment approaches. METHODS To obtain an understanding of the differences in single cells between primary and recurrent chordomas, we performed single-cell RNA sequencing and T-cell/B-cell receptor (BCR) sequencing. This allowed us to delineate the differences between the two types of tumour cells, tumour-infiltrating lymphocytes, myeloid cells, fibroblasts and B cells. Copy number variants (CNVs) were detected and compared between the tumour types to assess heterogeneity. Selected samples were subjected to immunohistochemistry to validate protein expression. Fluorescence in situ hybridisation experiments, Transwell assays and xenograft mouse models helped verify the role of fibronectin 1 (FN1) in chordoma. RESULTS Promoting natural killer (NK) cell and CD8_GZMK T-cell function or inhibiting the transformation of CD8_GZMK T cells to CD8_ZNF683 T cells and promoting the transformation of natural killer T (NKT) cells to NK cells are promising strategies for preventing chordoma recurrence. Additionally, inhibiting the M2-like activity of tumour-associated macrophages (TAMs) could be an effective approach. Antigen-presenting cancer-associated fibroblasts (apCAFs) and dendritic cells (DCs) with high enrichment of the antigen-presenting signature were enriched in primary chordomas. There were fewer plasma cells and BCR clonotypes in recurrent chordomas. Remarkably, FN1 was upregulated, had more CNVs, and was more highly secreted by tumours, macrophages, CD4 T cells, CD8 T cells and fibroblasts in recurrent chordoma than in primary chordoma. Finally, FN1 enhanced the invasion and proliferation of chordomas in vivo and in vitro. CONCLUSION Our comprehensive picture of the microenvironment of primary and recurrent chordomas provides deep insights into the mechanisms of chordoma recurrence. FN1 is an important target for chordoma therapy.
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Affiliation(s)
- Xulei Huo
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Sihan Ma
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Can Wang
- Department of Neuro‐oncologyCancer CenterBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Lairong Song
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Bohan Yao
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Sipeng Zhu
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Peiran Li
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Liang Wang
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zhen Wu
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Ke Wang
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
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Huang Z, Tong Y, Kong Q. Construction of a Tool to Predict Overall Survival of Patients With Primary Spinal Tumors After Surgical Resection: A Real-World Analysis Based on the Surveillance, Epidemiology, and End Results Database. Global Spine J 2023; 13:2422-2431. [PMID: 35341359 PMCID: PMC10538349 DOI: 10.1177/21925682221086539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We aim to construct a practical clinical prediction model to accurately evaluate the overall survival (OS) of patients with primary spinal tumors after primary tumor resection, thereby aiding clinical decision-making. METHODS A total of 695 patients diagnosed with a primary spinal tumor, selected from the Surveillance, Epidemiology, and End Results (SEER) database, were included in this study. The Cox regression algorithm was applied to the training cohort to build the prognostic nomogram model. The nomogram's performance in terms of discrimination, calibration, and clinical usefulness was also assessed in the internal SEER validation cohort. The fitted prognostic nomogram was then used to create a web-based calculator. RESULTS Four independent prognostic factors were identified to establish a nomogram model for patients with primary spinal tumors who had undergone surgical resection. The C-index (.757 for the training cohort and .681 for the validation cohort) and the area under the curve values over time (both >.68) showed that the model exhibited satisfactory discrimination in both the SEER cohort. The calibration curve revealed that the projected and actual survival rates are very similar. The decision curve analysis also revealed that the model is clinically valuable and capable of identifying high-risk patients. CONCLUSIONS After developing a nomogram and a web-based calculator, we were able to reliably forecast the postoperative OS of patients with primary spinal tumors. These tools are expected to play an important role in clinical practice, informing clinicians in making decisions about patient care after surgery.
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Affiliation(s)
- Zhangheng Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuexin Tong
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Qingquan Kong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Morris JM, Wentworth A, Houdek MT, Karim SM, Clarke MJ, Daniels DJ, Rose PS. The Role of 3D Printing in Treatment Planning of Spine and Sacral Tumors. Neuroimaging Clin N Am 2023; 33:507-529. [PMID: 37356866 DOI: 10.1016/j.nic.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size patient-specific anatomic and pathologic models to improve preoperative understanding of patient anatomy and pathology. Additionally, virtual surgical planning using medical computer-aided design software has enabled surgeons to create patient-specific surgical plans and simulate procedures in a virtual environment. This has resulted in reduced operative times, decreased complications, and improved patient outcomes. Combined with new surgical techniques, 3D-printed custom medical devices and instruments using titanium and biocompatible resins and polyamides have allowed innovative reconstructions.
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Affiliation(s)
- Jonathan M Morris
- Division of Neuroradiology, Department of Radiology, Anatomic Modeling Unit, Biomedical and Scientific Visualization, Mayo Clinic, 200 1st Street, Southwest, Rochester, MN, 55905, USA.
| | - Adam Wentworth
- Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - S Mohammed Karim
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Peter S Rose
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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15
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Wang D, Liu F, Li B, Xu J, Gong H, Yang M, Wan W, Jiao J, Liu Y, Xiao J. Development and Validation of a Prognostic Model for Overall Survival in Patients with Primary Pelvis and Spine Osteosarcoma: A Population-Based Study and External Validation. J Clin Med 2023; 12:jcm12072521. [PMID: 37048606 PMCID: PMC10095419 DOI: 10.3390/jcm12072521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Primary pelvis and spine osteosarcoma (PSOS) is a specific type of osteosarcoma that is difficult to treat and has a poor prognosis. In recent years, the research on osteosarcoma has been increasing, but there have been few studies on PSOS; in particular, there have been a lack of analyses with a large sample size. This study aimed to construct and validate a model to predict the overall survival (OS) of PSOS patients, as currently there are no tools available for assessing their prognosis. Methods: Data including demographic information, clinical characteristics, and follow-up information on patients with PSOS were collected from the Surveillance, Epidemiology, and End Results (SEER) database, as well as from the Spine Tumor Center of Changzheng Hospital. Variable selection was achieved through a backward procedure based on the Akaike Information Criterion (AIC). Prognostic factors were identified by univariate and multivariate Cox analysis. A nomogram was further constructed for the estimation of 1-, 3-, and 5-year OS. Calibration plots, the concordance index (C-index), and the receiver operating characteristic (ROC) were used to evaluate the prediction model. Results: In total, 83 PSOS patients and 90 PSOS patients were separately collected from the SEER database and Changzheng Hospital. In the SEER cohort, liver metastasis, lung metastasis, and chemotherapy were recognized as independent prognostic factors for OS (p < 0.05) and were incorporated to construct the initial nomogram. However, the initial nomogram showed poor predictive accuracy in internal and external validation. Then, we shifted our focus to the Changzheng data. Lung metastasis involving segments, Eastern Cooperative Oncology Group (ECOG) performance score, alkaline phosphatase (ALP) level, and en bloc resection were ultimately identified as independent prognostic factors for OS (p < 0.05) and were further incorporated to construct the current nomogram, of which the bias-corrected C-index was 0.834 (0.824–0.856). The areas under the ROC curves (AUCs) of the current nomogram regarding 1-, 3-, and 5-year OS probabilities were 0.93, 0.96, and 0.92, respectively. Conclusion: We have developed a predictive model with satisfactory performance and clinical practicability, enabling effective prediction of the OS of PSOS patients and aiding clinicians in decision-making.
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Affiliation(s)
- Da Wang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Fanrong Liu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - Binbin Li
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Jinhui Xu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Haiyi Gong
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Minglei Yang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Wei Wan
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Jian Jiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
- Correspondence: (J.J.); (Y.L.); (J.X.)
| | - Yujie Liu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
- Correspondence: (J.J.); (Y.L.); (J.X.)
| | - Jianru Xiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
- Correspondence: (J.J.); (Y.L.); (J.X.)
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16
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Patel S, Nunna RS, Nie J, Ansari D, Chaudhry NS, Mehta AI. Incidence, Management, and Outcomes of Adult Spinal Chordoma Patients in the United States. Global Spine J 2023; 13:334-343. [PMID: 33583227 PMCID: PMC9972264 DOI: 10.1177/2192568221995155] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment. Gold standard treatment remains en-bloc surgical resection with questionable efficacy of adjuvant therapies such as radiation and chemotherapy. Here we provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chordoma. METHODS Patients with diagnosis codes specific for chordoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. RESULTS 1,548 individuals were identified with a diagnosis of chordoma, 60.9% of which were at the sacrum or coccyx and 39.1% at the spine. The mean overall survival of patients in our cohort was 8.2 years. Increased age, larger tumor size, and presence of metastases were associated with worsened overall survival. 71.2% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received proton-based radiation had significantly improved overall survival compared to traditional radiation. CONCLUSION Surgical resection significantly improves overall survival in patients with spinal chordoma. In those patients receiving radiation, those who receive proton-based modalities have improved overall survival. Further studies into proton radiotherapy doses are required.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - Ravi S. Nunna
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - James Nie
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | | | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA,Ankit I. Mehta, Department of Neurosurgery,
University of Illinois at Chicago, 912 South Wood Street, 451-N, Chicago, IL,
60612, USA.
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17
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Murphey MD, Minn MJ, Contreras AL, Koeller KK, Shih RY, Inwards CY, Yamaguchi T. Imaging of spinal chordoma and benign notochordal cell tumor (BNCT) with radiologic pathologic correlation. Skeletal Radiol 2023; 52:349-363. [PMID: 36063190 DOI: 10.1007/s00256-022-04158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
Benign notochordal cell tumor (BNCT) and chordoma are neoplasms of notochordal differentiation. BNCT represents notochordal rests, commonly an incidental lesion present in the spine in 19% of cadaveric specimens. BNCTs are often radiographically occult. CT of BNCT frequently reveals patchy sclerosis between areas of maintained underlying trabeculae. BNCT demonstrates marrow replacement on T1-weighted MR images with high signal intensity on T2-weighting. BNCTs are frequently smaller than 35 mm and lack significant enhancement, bone destruction, cortical permeation, or soft tissue components. Biopsy or surgical resection of BNCT is usually not warranted, although imaging surveillance may be indicated. Chordoma is a rare low-grade locally aggressive malignancy representing 1-4% of primary malignant bone tumors. Chordoma is most frequent between the ages of 50-60 years with a male predilection. Clinical symptoms, while nonspecific and location dependent, include back pain, numbness, myelopathy, and bowel/bladder incontinence. Unfortunately, lesions are often large at presentation owing to diagnosis delay. Imaging of chordoma shows variable mixtures of bone destruction and sclerosis, calcification (50-70% at CT) and large soft tissue components. MR imaging of chordoma reveals multilobulated areas of marrow replacement on T1-weighting and high signal intensity on T2-weighting reflecting the myxoid component within the lesion and areas of hemorrhage seen histologically. Treatment of chordoma is primarily surgical with prognosis related to resection extent. Unfortunately, complete resection is often not possible (21-75%) resulting in high local recurrence incidence (19-75%) and a 5-year survival rate of 45-86%. This article reviews and illustrates the clinical characteristics, pathologic features, imaging appearance spectrum, treatment, and prognosis of BNCT and spinal chordoma.
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Affiliation(s)
- Mark D Murphey
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA. .,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA. .,Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA.
| | - Matthew J Minn
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA.,Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA.,Department of Radiology, Scripps Green Hospital, 10666 N. Torrey Pines Road, La Jolla, CA, 92037, USA
| | | | - Kelly K Koeller
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA.,Department of Radiology, Head and Neck Cancer Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert Y Shih
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA
| | - Carrie Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Takehiko Yamaguchi
- Department of Pathology, Nikko Medical Center, Dokkyo Medical University, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
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Moscinksi N, Sullivan PZ, Gokaslan ZL. Benign primary bone tumors, long-term management into adulthood. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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19
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Outcomes of Recurrent Mobile Spine Chordomas. J Am Acad Orthop Surg 2023; 31:e278-e286. [PMID: 36729745 DOI: 10.5435/jaaos-d-22-00621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/20/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Chordomas of the mobile spine are rare malignant tumors. The purpose of this study was to review the outcomes of treatment for patients with recurrent mobile spine chordomas. METHODS The oncologic outcomes and survival of 30 patients undergoing treatment of a recurrent mobile spine chordoma were assessed over a 24-year period. The mean follow-up was 3.5 years. RESULTS In patients presenting with a recurrent mobile spine chordoma, the mean 2- and 5-year overall survival was 73% and 39%, respectively. Enneking appropriate resection trended toward improved overall survival at 5 years (100% vs. 32%, P = 0.24). Those undergoing surgical resection for recurrence had improved metastatic-free survival (hazard ratio 0.29, CI 0.08 to 0.99, P = 0.05). Positive margins were found to be a risk factor of further local recurrence (hazard ratio 7.92, CI 1.02 to 61.49, P = 0.04). Those undergoing nonsurgical management trended toward having an increase in new neurologic deficits (P = 0.09), however, there was no difference in overall complications based on treatment type (P = 0.13). CONCLUSION Recurrent mobile spine chordoma portends a poor prognosis with an overall survival of less than 40% at 5 years. Surgical resection may help prevent new neurologic deficits and tumor metastasis while en bloc excision with negative surgical margins is associated with improved local recurrence-free survival.
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Clinical outcomes and toxicities of 100 patients treated with proton therapy for chordoma on the proton collaborative group prospective registry. Radiother Oncol 2023; 183:109551. [PMID: 36813169 DOI: 10.1016/j.radonc.2023.109551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND We present efficacy and toxicity outcomes among patients with chordoma treated on the Proton Collaborative Group prospective registry. METHODS Consecutive chordoma patients treated between 2010-2018 were evaluated. One hundred fifty patients were identified, 100 had adequate follow-up information. Locations included base of skull (61%), spine (23%), and sacrum (16%). Patients had a performance status of ECOG 0-1 (82%) and median age of 58 years. Eighty-five percent of patients underwent surgical resection. The median proton RT dose was 74 Gy (RBE) (range 21-86 Gy (RBE)) using passive scatter proton RT (PS-PBT) (13%), uniform scanning proton RT (US-PBT) (54%) and pencil beam scanning proton RT (PBS-PBT) (33%). Rates of local control (LC), progression-free survival (PFS), overall survival (OS) and acute and late toxicities were assessed. RESULTS 2/3-year LC, PFS, and OS rates are 97%/94%, 89%/74%, and 89%/83%, respectively. LC did not differ based on surgical resection (p = 0.61), though this is likely limited by most patients having undergone a prior resection. Eight patients experienced acute grade 3 toxicities, most commonly pain (n = 3), radiation dermatitis (n = 2), fatigue (n = 1), insomnia (n = 1) and dizziness (n = 1). No grade ≥ 4 acute toxicities were reported. No grade ≥ 3 late toxicities were reported, and most common grade 2 toxicities were fatigue (n = 5), headache (n = 2), CNS necrosis (n = 1), and pain (n = 1). CONCLUSIONS In our series, PBT achieved excellent safety and efficacy outcomes with very low rates of treatment failure. CNS necrosis is exceedingly low (<1%) despite the high doses of PBT delivered. Further maturation of data and larger patient numbers are necessary to optimize therapy in chordoma.
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21
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Elafram R, Abcha O, Romdhane MB, Sghaier M, Annabi H. Chordoma of the lumbar spine—A potential diagnosis not to be forgotten! Radiol Case Rep 2023; 18:506-510. [DOI: 10.1016/j.radcr.2022.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022] Open
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Berjano P, Baroncini A, Cecchinato R, Langella F, Boriani S. En-bloc resection of a chordoma in L3 by a combined open posterior and less invasive retroperitoneal approach: technical description and case report. Arch Orthop Trauma Surg 2023; 143:801-808. [PMID: 34562120 DOI: 10.1007/s00402-021-04177-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To fulfill oncological criteria, extensive open anterior and posterior approaches are usually performed in the lumbar spine to obtain an appropriate en-bloc spondylectomy. It is commonly accepted that the price of a tumor-free margin includes such extensive incisions and soft-tissue damage, with consequent relevant blood loss and possible postoperative complications as delayed wound healing. In this article, a case of chordoma in L3 is presented, submitted to an oncologically appropriate en-bloc resection performed by an open posterior approach combined with a mini-retroperitoneal approach. The successful oncologic procedure was combined with a short and uneventful postoperative course. MATERIALS AND METHODS The authors present the surgical technique and the possible challenges of minimally invasive anterior oncologic surgery as a contribution to a limited literature. RESULTS Up to date, palliative care of single metastases has been the main setting in which anterior, minimally invasive surgery has been performed in the lumbar spine. The authors explained how, in selected cases, this approach can be performed in combination with an open posterior access for an oncologically appropriate treatment of a primary malignant tumor. CONCLUSION Anterior, minimally invasive surgery can have a role in selected patients with primary malignant tumors of the lumbar spine. The surgical team should have extensive training both in oncologic and minimally invasive surgery.
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Affiliation(s)
- Pedro Berjano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Alice Baroncini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Department of Orthopaedics, RWTH Uniklinik Aachen, Aachen, Germany.
| | - Riccardo Cecchinato
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesco Langella
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Stefano Boriani
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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23
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Bai J, Shi J, Zhang Y, Li C, Xiong Y, Koka H, Wang D, Zhang T, Song L, Luo W, Zhu B, Hicks B, Hutchinson A, Kirk E, Troester MA, Li M, Shen Y, Ma T, Wang J, Liu X, Wang S, Gui S, McMaster ML, Chanock SJ, Parry DM, Goldstein AM, Yang XR. Gene Expression Profiling Identifies Two Chordoma Subtypes Associated with Distinct Molecular Mechanisms and Clinical Outcomes. Clin Cancer Res 2023; 29:261-270. [PMID: 36260525 PMCID: PMC11293090 DOI: 10.1158/1078-0432.ccr-22-1865] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/30/2022] [Accepted: 10/17/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Chordoma is a rare bone tumor with a high recurrence rate and limited treatment options. The aim of this study was to identify molecular subtypes of chordoma that may improve clinical management. EXPERIMENTAL DESIGN We conducted RNA sequencing in 48 tumors from patients with Chinese skull-base chordoma and identified two major molecular subtypes. We then replicated the classification using a NanoString panel in 48 patients with chordoma from North America. RESULTS Tumors in one subtype were more likely to have somatic mutations and reduced expression in chromatin remodeling genes, such as PBRM1 and SETD2, whereas the other subtype was characterized by the upregulation of genes in epithelial-mesenchymal transition and Sonic Hedgehog pathways. IHC staining of top differentially expressed genes between the two subtypes in 312 patients with Chinese chordoma with long-term follow-up data showed that the expression of some markers such as PTCH1 was significantly associated with survival outcomes. CONCLUSIONS Our findings may improve the understanding of subtype-specific tumorigenesis of chordoma and inform clinical prognostication and targeted options.
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Affiliation(s)
- Jiwei Bai
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Yazhuo Zhang
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China
| | - Yujia Xiong
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
| | - Hela Koka
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Difei Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Tongwu Zhang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Lei Song
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Wen Luo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Belynda Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Erin Kirk
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
| | - Melissa A. Troester
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
| | - Mingxuan Li
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
| | - Yutao Shen
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
| | - Tianshun Ma
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
| | - Junmei Wang
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China
| | - Xing Liu
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China
| | - Shuai Wang
- Beijing Neurosurgery Institute, Capital Medical University, Beijing, 100070, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Mary L. McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Dilys M. Parry
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Alisa M. Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Xiaohong R. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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Wang X, Chen Z, Li B, Fan J, Xu W, Xiao J. Immunotherapy as a Promising Option for the Treatment of Advanced Chordoma: A Systemic Review. Cancers (Basel) 2022; 15:cancers15010264. [PMID: 36612259 PMCID: PMC9818311 DOI: 10.3390/cancers15010264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To summarize the function and efficacy of immunotherapy as an adjunctive therapy in the treatment of advanced chordoma. METHODS Literature search was conducted by two reviewers independently. Case reports, case series and clinical trials of immunotherapy for chordoma were retrieved systematically from Pubmed, Web of Science, Scoupus and Cochrane Library. Clinical outcome data extracted from the literature included median progression-free survival (PFS), median overall survival (OS), clinical responses and adverse events (AEs). RESULTS All studies were published between 2015 and 2022. Twenty-two eligible studies were selected for systemic review. PD-1/PD-L1 immune checkpoint inhibitors (ICIs) were the most common used immunotherapy agents in chordoma, among which Pembrolizumab was the most frequently prescribed. CTLA-4 antibody was only used as combination therapy in chordoma. Dose Limiting Toxicity (DLT) was not observed in any vaccine targeting brachyury, and injection site response was the most frequent AV. The response evaluation criteria in solid tumors (RECIST) were the most generally used evaluation standard in chordoma immunotherapy, and none of the included studies employed the Choi criteria. CONCLUSIONS No clinical data have demonstrated that CTLA-4 ICIs combined with PD-1/PD-L1 ICIs is more effective than ICIs monotherapy in treating chordoma, and ICIs in combination with other therapies exhibit more toxicity than monotherapy. PD-1/PD-L1 ICIs monotherapy is recommended as an immunotherapy in patients with advanced chordoma, which may even benefit PD-L1-negative patients. The brachyury vaccine has shown good safety in chordoma patients, and future clinical trials should focus on how to improve its therapeutic efficacy. The use of immunomodulatory agents is a promising therapeutic option, though additional clinical trials are required to evaluate their safety and effectiveness. RECIST does not seem to be an appropriate standard for assessing medications of intratumoral immunotherapy.
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Affiliation(s)
| | | | | | | | - Wei Xu
- Correspondence: (W.X.); (J.X.); Tel./Fax: +86-021-13761278657 (W.X.); +86-021-13701785283 (J.X.); +(086)-021-81885634 (W.X. & J.X.)
| | - Jianru Xiao
- Correspondence: (W.X.); (J.X.); Tel./Fax: +86-021-13761278657 (W.X.); +86-021-13701785283 (J.X.); +(086)-021-81885634 (W.X. & J.X.)
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Pinter ZW, Moore EJ, Rose PS, Nassr AN, Currier BL. En bloc resection of a high cervical chordoma followed by reconstruction with a free vascularized fibular graft: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22305. [PMID: 36536523 PMCID: PMC9764371 DOI: 10.3171/case22305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Wide excision of chordoma provides better local control than intralesional resection or definitive radiotherapy. The en bloc excision of high cervical chordomas is a challenging endeavor because of the complex anatomy of this region and limited reconstructive options. OBSERVATIONS This is the first case report to describe reconstruction with a free vascularized fibular graft following the en bloc excision of a chordoma involving C1-3. LESSONS This report demonstrates the durability of this construct at 10-year follow-up and is the first case report demonstrating satisfactory long-term oncological outcomes after a true margin-negative resection of a high cervical chordoma.
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Affiliation(s)
| | - Eric J. Moore
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Ahmad N. Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
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Hu P, Du S, Wei F, Zhai S, Zhou H, Liu X, Liu Z. Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh. Front Oncol 2022; 12:1065303. [PMID: 36601475 PMCID: PMC9806260 DOI: 10.3389/fonc.2022.1065303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Background Surgical resection of C2 vertebral tumors is challenging owing to the complex anatomy of C2 vertebrae and the challenges to surgical exposure. Various surgical approaches are available, but some are associated with excessively high risks of complications. An additional challenge is reconstruction of the upper cervical spine following surgery. In the last decade, additive-manufacturing personalized artificial vertebral bodies (AVBs) have been introduced for the repair of large, irregular bony defects; however, their use and efficacy in upper cervical surgery have not been well addressed. Therefore, in this study, we compared instrumented fixation status between patients who underwent conventional titanium mesh reconstruction and those who underwent the same resection but with personalized AVBs. Methods We performed a retrospective comparative study and recruited a single-institution cohort of patients with C2 vertebral tumors. Clinical data and imaging findings were reviewed. Through data processing and comparative analysis, we described and discussed the feasibility and safety of surgical resection and the outcomes of hardware implants. The primary outcome of this study was instrumented fixation status. Results The 31 recruited patients were divided into two groups. There were 13 patients in group A who underwent conventional titanium mesh reconstruction and 18 group B patients who underwent personalized AVBs. All patients underwent staged posterior and anterior surgical procedures. In the cohort, 9.7% achieved total en bloc resection of the tumor, while gross total resection was achieved in the remaining 90.3%. The perioperative complication and mortality rates were 45.2% and 6.5%, respectively. The occurrence of perioperative complications was related to the choice of anterior approach (p < 0.05). Group A had a higher complication rate than group B (p < 0.05). Four patients (4/13, 30.8%) developed hardware problems during the follow-up period; however, this rate was marginally higher than that of group B (1/18, 5.6%). Conclusions Total resection of C2 vertebral tumors was associated with a high risk of perioperative complications. The staged posterior and retropharyngeal approaches are better surgical strategies for C2 tumors. Personalized AVBs can provide a reliable reconstruction outcome, yet minor pitfalls remain that call for further modification.
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Affiliation(s)
- Panpan Hu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Suiyong Du
- Department of Spine Surgery, 521 Hospital of Norinco Group, Xi’an, China
| | - Feng Wei
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,*Correspondence: Feng Wei,
| | - Shuheng Zhai
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Hua Zhou
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
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Kassels AC, Melamed J, Rogers A, Johnstone D. Thoracic chordoma in a 36-year-old female. J Surg Case Rep 2022; 2022:rjac541. [PMID: 36479224 PMCID: PMC9722240 DOI: 10.1093/jscr/rjac541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chordomas are rare tumors that occur in the bones of the skull base and spine, affecting 1 in 1 000 000 people per year. Thoracic chordomas comprise just 1% of chordomas. A 36-year-old female underwent a right video-assisted thoracoscopic surgical resection for a cystic mass at the level of T2-3 which was well-circumscribed. Despite efforts to achieve an intact resection, there was tumor spillage due to friability, and it was taken off the bony vertebral body with no margin. The final pathologic diagnosis was chordoma. Thoracic chordomas are rare, slow-growing, recurring neoplasms that require proper preoperative diagnostic imaging and ideally preoperative trocar computed tomography-guided biopsy from a posterior approach if anatomic access is possible. They are prone to dissemination and sarcomatous differentiation. The surgical approaches for reported thoracic chordoma tumors vary due to their rarity and the variation in tumor location and presentation.
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Affiliation(s)
- Austin C Kassels
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joshua Melamed
- Correspondence address. Department of Surgery, Division of Cardiothoracic Surgery, 5th Floor, HUB for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd. Milwaukee, WI 53226, USA. Tel: +1-310-966-7939; Fax: +1-414-955-0079; E-mail:
| | - Austin Rogers
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David Johnstone
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Jae-Min Park A, McDowell S, Mesfin A. Management of Chordoma of the Sacrum and Mobile Spine. JBJS Rev 2022; 10:01874474-202212000-00004. [PMID: 36639876 DOI: 10.2106/jbjs.rvw.22.00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
➢ Chordomas account for 1% to 4% of primary tumors of the spine and sacrum. ➢ En bloc resection is the preferred surgical treatment for the management of chordomas. ➢ Proton beam radiation is increasingly being used as a postoperative radiation modality for the treatment of chordomas.
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Affiliation(s)
- Andrew Jae-Min Park
- Department of Orthopedic Surgery and Physical Performance, University of Rochester School of Medicine & Dentistry, Rochester, New York
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Lu M, Zhou Z, Chen W, Lei Z, Dai S, Hou C, Du S, Jin Q, Jin D, Boriani S, Li H. En bloc resection of huge primary tumors with epidural involvement in the mobile spine using the “rotation–reversion” technique: Feasibility, safety, and clinical outcome of 11 cases. Front Oncol 2022; 12:1031708. [DOI: 10.3389/fonc.2022.1031708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundEn bloc resection of spinal tumors provides better local control and survival outcomes than intralesional resection. Safe margins during en bloc resection of primary spinal tumors with epidural involvement are required for improved outcomes. The present study describes a “rotation–reversion” technique that has been used for en bloc resection of huge primary tumors in the mobile spine with epidural involvement and reported the clinical outcomes in these patients.MethodsAll patients with primary spinal tumors who were treated with the rotation–reversion technique at our institution between 2015 and 2021 were evaluated retrospectively. Of the patients identified, those with both huge extraosseous soft-tissue masses and epidural involvement were selected for a case review. Clinical and radiological characteristics, pathologic findings, operative procedures, complications, and oncological and functional outcomes of these patients were reviewed.ResultsOf the 86 patients identified with primary spinal tumors who underwent en bloc resection using the rotation–reversion technique between 2015 and 2021, 11 had huge extraosseous soft-tissue masses with epidural involvement in the mobile spine. The average maximum size of these 11 tumors was 8.1 × 7.5 × 9.7 cm. Median follow-up time was 28.1 months, mean operation time was 849.1 min (range 465–1,340 min), and mean blood loss was 6,972.7 ml (range 2,500–17,700 ml), with 10 (91%) of the 11 patients experiencing perioperative complications. The negative margin rate was 91%, with only one patient (9%) experiencing local recurrence. Ten patients were able to walk normally or with a crutch at the last follow-up, whereas one was completely paralyzed preoperatively.ConclusionThe rotation–reversion technique is an effective procedure for the en bloc resection of huge primary spinal tumors, with the extension of invasion in selected patients including not only the vertebral body but also the pedicle and part of the posterior arch.
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Huo X, Guo T, Wang K, Yao B, Li D, Li H, Chen W, Wang L, Wu Z. Methylation-based reclassification and risk stratification of skull-base chordomas. Front Oncol 2022; 12:960005. [PMID: 36439461 PMCID: PMC9691996 DOI: 10.3389/fonc.2022.960005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/11/2022] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Skull-base chordomas are rare malignant bone cancers originating from the remnant of the notochord. Survival is variable, and clinical or molecular factors cannot reliably predict their outcomes. This study therefore identified epigenetic subtypes that defined new chordoma epigenetic profiles and their corresponding characteristics. METHODS Methylation profiles of 46 chordoma-resected neoplasms between 2008 and 2014, along with clinical information, were collected. K-means consensus clustering and principal component analysis were used to identify and validate the clusters. Single-sample gene set enrichment analysis, methylCIBERSORT algorithm, and copy number analysis were used to identify the characteristics of the clusters. RESULTS Unsupervised clustering analysis confirmed two clusters with a progression-free survival difference. Gene set enrichment analysis indicated that the early and late estrogen response pathways and the hypoxia pathway were activated whereas the inflammatory and interferon gamma responses were suppressed. Forty-six potential therapeutic targets corresponding to differentially methylated sites were identified from chordoma patients. Subgroups with a worse outcome were characterized by low immune cell infiltration, higher tumor purity, and higher stemness indices. Moreover, copy number amplifications mostly occurred in cluster 1 tumors and the high-risk group. Additionally, the presence of a CCNE1 deletion was exclusively found in the group of chordoma patients with better outcome, whereas RB1 and CDKN2A/2B deletions were mainly found in the group of chordoma patients with worse outcome. CONCLUSIONS Chordoma prognostic epigenetic subtypes were identified, and their corresponding characteristics were found to be variable.
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Affiliation(s)
- Xulei Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Tengxian Guo
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Ke Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Bohan Yao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Huan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Wei Chen
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Liang Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
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Association of radical vs palliative resection of spinal chordoma with survival: a population-based study. Acta Neurol Belg 2022:10.1007/s13760-022-02136-3. [DOI: 10.1007/s13760-022-02136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
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Huo X, Wang K, Song L, Yang Y, Zhu S, Ma J, Tian K, Fan Y, Wang L, Wu Z. Bibliometric analysis of publication trends in chordoma research (1992−2021). INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Xu W, Ye C, Zhang D, Wang P, Wei H, Yang X, Xiao J. One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis. Front Surg 2022; 9:844611. [PMID: 36061059 PMCID: PMC9428343 DOI: 10.3389/fsurg.2022.844611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Study designRetrospective case series.ObjectiveTo describe the technique details and therapeutic outcomes of 3-D printing model-guided en bloc resection of chondrosarcoma (CHS) with huge paravertebral mass via the combined posterior median and Wiltse approach.Summary of background dataTotal en bloc spondylectomy (TES) technique is conventionally based on the single posterior approach or combined anterior-posterior approach. However, the single posterior approach imposes a high technical demand on the surgeon due to the narrow field of vision, limited surgical space and the delicate spinal cord, while the combined anterior-posterior approach not only requires greater patient tolerance but is time consuming and runs the risk of more blood loss and injury to the visceral pleura and large blood vessels during surgery. In addition, it is difficult to completely remove the thoracic CHS with paravertebral mass through simple en bloc resection when it involves the aorta, vena cava, costa and lung.Material and methodsBetween August 2010 and January 2016, we performed a retrospective study to evaluate the clinical characteristics and outcomes of en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. Postoperative recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method. P values less than 0.05 were considered statistically significant.ResultsAltogether 15 patients received en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. The mean age of these patients was 37.0 ± 12.8 years (median 36; range 15–64). This combination approach provided more extensive exposure and wider marginal resection of the tumor within a mean operation duration of 288 ± 96 min (median 280; range 140–480) and mean intraoperative blood loss of 1,966 ± 830 ml (median 2,000; range 300–3,000). Of the 15 patients, 5 experienced local recurrence of the disease; the mean time from surgery to recurrence was 22 ± 9.85 months (median 17, range 13–35). RFS in patients with recurrent CHS was significantly lower than that in patients with primary CHS on admission (p = 0.05).ConclusionsThe combined posterior median and Wiltse approach is a technically viable option for en bloc resection of thoracic spinal CHS with huge paravertebral mass, and can give a favorable local control of CHS.Level of evidenceLevel V.
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Affiliation(s)
- Wei Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chen Ye
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Dan Zhang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Peng Wang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haifeng Wei
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Correspondence: Jianru Xiao Xinghai Yang
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Correspondence: Jianru Xiao Xinghai Yang
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Jabbar R, Jankowski J, Pawełczyk A, Szmyd B, Solek J, Pierzak O, Wojdyn M, Radek M. Cervical Paraspinal Chordoma: A Literature Review with a Novel Case Report. J Clin Med 2022; 11:jcm11144117. [PMID: 35887879 PMCID: PMC9325254 DOI: 10.3390/jcm11144117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Chordomas are rare malignant neoplasms, accounting for 1–4% of all primary bone tumors. Most spinal chordomas occur in the sacrococcygeal region and the base of the skull; however, 6% of chordomas are observed in the cervical spine. In these cases, the lesion is mainly located in the midline. These tumors slowly grow before becoming symptomatic and encase the surrounding vascular and nerve structures. Patients with advanced chordoma have a poor prognosis due to local recurrence with infiltration and destruction of adjacent bone and tissues. Systemic chemotherapy options have not been fully effective in these tumors, especially for recurrent chordomas. Thus, new combinations of currently available targeted molecular and biological therapies with radiotherapy have been proposed as potential treatment modalities. Here, the present paper describes the case of a 41-year-old male with a C2–C4 chordoma located paravertebrally, who underwent surgical resection with a debulking procedure for a cervical chordoma. Computed tomography angiography revealed a paraspinal mass with bone remodeling and the MRI showed a paravertebral mass penetrating to the spinal canal with a widening of the intervertebral C2–C3 foramen. Initially, the tumor was diagnosed as schwannoma based on its localization and imaging features; however, the histopathology specimen confirmed the diagnosis of chordoma. This case study highlights the effectivity of radical surgical resection as a mainstay treatment for chordomas, discusses neuroimaging, diagnosis, and the use of currently available targeted therapies and forthcoming treatment strategies, as alternative treatment options for chordoma.
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Affiliation(s)
- Redwan Jabbar
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Jakub Jankowski
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Agnieszka Pawełczyk
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Bartosz Szmyd
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Julia Solek
- Department of Pathology, Chair of Oncology, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Olaf Pierzak
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Maciej Wojdyn
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
- Correspondence:
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Aoki S, Koto M, Ikawa H, Imai R, Tokuhiko O, Shinoto M, Takiyama H, Yamada S, Tsuji H. Long-term outcomes of high dose carbon-ion radiation therapy for unresectable upper cervical (C1-2) chordoma. Head Neck 2022; 44:2162-2170. [PMID: 35734902 PMCID: PMC9544549 DOI: 10.1002/hed.27127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background Chordoma is a rare, locally invasive neoplasm of the axial skeleton. Complete resection is often difficult, especially for the upper‐cervical (C1‐2) spine. We evaluated the efficacy and safety of carbon‐ion radiotherapy (CIRT) for unresectable C1‐2 chordoma. Methods Patients with C1‐2 chordoma treated with definitive CIRT (60.8 Gy [RBE] in 16 fractions) were retrospectively analyzed. We evaluated OS, LC, PFS, and toxicity. Results Nineteen eligible patients all completed the planned course of CIRT. With the median follow‐up 68 months (range: 29–144), median OS was 126 months (range: 36‐NA). Five‐year OS, LC, and PFS were 68.4% (95% CI, 42.8%–84.4%), 75.2% (46.1%–90.0%), and 64.1% (36.3%–82.3%), respectively. Regarding acute toxicity of grade ≥3, there was only one grade 3 mucositis. Late toxicity included radiation‐induced myelitis (grade 3 in 1 patient; 5.3%), and compression fractures (n = 5; 26.3%). Conclusions High‐dose CIRT is a promising treatment option for unresectable upper cervical chordoma.
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Affiliation(s)
- Shuri Aoki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan.,Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hiroaki Ikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Reiko Imai
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Omatsu Tokuhiko
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Makoto Shinoto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hirotoshi Takiyama
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
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Smith E, Hegde G, Czyz M, Hughes S, Haleem S, Grainger M, James SL, Botchu R. A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know? Indian J Radiol Imaging 2022; 32:205-212. [PMID: 35924121 PMCID: PMC9340175 DOI: 10.1055/s-0042-1744162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
AbstractEn bloc resection in the spine is performed for both primary and metastatic bone lesions and has been proven to lengthen disease-free survival and decrease the likelihood of local recurrence. It is a complex procedure, which requires a thorough multi-disciplinary approach. This article will discuss the role of the radiologist in characterizing the underlying tumor pathology, staging the tumor and helping to predict possible intraoperative challenges for en bloc resection of primary bone lesions. The postoperative appearances and complications following en bloc resection in the spine will be considered in subsequent articles.
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Affiliation(s)
- E. Smith
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - G. Hegde
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M. Czyz
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. Hughes
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. Haleem
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M. Grainger
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. L. James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - R. Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
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Jang SJ, Han N, Hong EK, Gwak HS. Recurrent L3 Chordoma Presented as Intradural Extramedullary Mass With Distant Metastasis: A Case Report. Brain Tumor Res Treat 2022; 10:123-128. [PMID: 35545833 PMCID: PMC9098983 DOI: 10.14791/btrt.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
Here, we report a rare case of L3 chordoma progressed to an intradural extramedullary (IDEM) mass and distant metastasis to the fascia lata. A 64-year old female patient presented to a local university hospital due to back pain and received excisional biopsy for a L3 destructive bony lesion. Local radiation therapy was initially administered, assuming a malignancy of unknown origin, but she developed cerebrospinal fluid leakage during adjuvant radiation therapy, which was managed by wound revision and lumbar drainage. As the destructive lesion progressed, she visited our hospital for a second opinion 3 months after the biopsy. After review of outside pathology, we diagnosed the lesion to be a chordoma, and performed a L3 corpectomy with cage and plate fixation. One and a half years later, positron emission tomography and computed tomography (PET-CT) revealed a right tensor fascia lata hypermetabolic lesion. Excisional biopsy confirmed a distant metastasis of the chordoma. One year later, she complained of L2 radiating pain. PET-CT and CT myelogram revealed an IDEM lesion. Surgical excision confirmed the transdural invasion of the chordoma. To our knowledge, this is the first report of an iatrogenic IDEM invasion and distant metastasis to the tensor of the fascia lata by a L3 chordoma.
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Affiliation(s)
- Soo Jin Jang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nayoung Han
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Eun Kyeong Hong
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Ho-Shin Gwak
- Department of Cancer Control, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.
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Chen ATC, Hong CBC, Narazaki DK, Rubin V, Serante AR, Ribeiro Junior U, de Lima LGCA, Coimbra BGMM, Cristante AF, Teixeira WGJ. High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes. J Neurooncol 2022; 158:23-31. [PMID: 35451720 DOI: 10.1007/s11060-022-04003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base. METHODS Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure. RESULTS A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63). CONCLUSION Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.
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Affiliation(s)
- Andre Tsin Chih Chen
- Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil.
| | - Carlos Bo Chur Hong
- Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil
| | - Douglas Kenji Narazaki
- Department of Spine Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Virginio Rubin
- Department of Radiology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Alexandre Ruggieri Serante
- Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Av. Dr. Arnaldo, 251, 4SS, São Paulo, SP, CEP 01246-000, Brazil
| | - Ulysses Ribeiro Junior
- Department of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | | | | | - Alexandre Fogaça Cristante
- Department of Spine Surgery of Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - William Gemio Jacobsen Teixeira
- Department of Spine Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
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Banfield W, Ioakeim-Ioannidou M, Goldberg S, Ahmed S, Schwab J, Cote G, Choy E, Shin J, Hornicek F, Liebsch N, Chen Y, MacDonald SM, DeLaney T. Definitive high-dose, proton-based radiation for unresected mobile spine and sacral chordomas. Radiother Oncol 2022; 171:139-145. [DOI: 10.1016/j.radonc.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/18/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
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Moune MY, Sayore CM, Hemama M, El Fatemi N, El Maaqili MR. Surgical management of a thoracic chordoma: A case report and literature review. Surg Neurol Int 2022; 13:63. [PMID: 35242429 PMCID: PMC8888287 DOI: 10.25259/sni_1227_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Chordomas are rare benign, but locally aggressive tumors that are regularly encountered in the clivus and sacrum. Although they are rarely found in the thoracic spine, they can contribute not only to local bone destruction and spinal instability, lead to cord compression, and major neurological deficits. Case Description: A 56 year-old-male originally underwent a T12 laminectomy with debulking for a thoracic chordoma. Two years later, the lesion recurred contributing to a significant paraparesis. The new MR showed a T2 hyper intense lesion with huge epidural extension that warranted a 360° surgical decompression and fusion. The histopathology from both surgeries confirmed the diagnosis of a chordoma. Conclusion: Combined 360° decompression and fusion was warranted to resect a T12 chordoma that recurred 2 years following an original laminectomy with debulking procedure.
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Berra LV, Armocida D, Palmieri M, Di Norcia V, D’Angelo L, Mongardini M, Vigliotta M, Maccari E, Santoro A. Sacral Nerves Reconstruction After Surgical Resection of a Large Sacral Chordoma Restores the Urinary and Sexual Functionality and the Anal Continence. Neurospine 2022; 19:155-162. [PMID: 35130427 PMCID: PMC8987555 DOI: 10.14245/ns.2142724.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Chordomas are slow-growing tumors, with a high tendency to local relapse. En bloc resection is related to the most favorable outcome in terms of survival but is frequently associated with permanent neurological deficits involving sphincters and sexual functions. In the present article, we describe an innovative technique of en bloc resection followed by reconstruction of the sacral nerves with nerve grafts.
Methods The chordoma was excised through a posterior approach after dividing the proximal and distal sacral nerves using the established technique. After that, a microsurgical S2-S3-S4 nerve reconstruction was performed connecting the proximal and distal stumps with sural nerve grafts withdrawn from both lower limbs.
Results Immediately after surgery, the patient experienced complete impairment of sexual function and sphincters with urinary and fecal incontinence. After 6 months, there was a progressive recovery of sexual function and sphincter control. One year after the operation, the patient achieved an adequate sexual life (erection and ejaculation) and complete control of the bladder and anal sphincter.
Conclusion Reconstruction of nerves sacrificed during sacral tumor removal has been shown to be effective in restoring sphincter and sexual function and is a promising technique that may significantly improve patients' quality of life.
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Affiliation(s)
- Luigi Valentino Berra
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
- Corresponding Author Luigi Valentino Berra https://orcid.org/0000-0003-2605-9089 Policlinico Umberto I, Sapienza Università di Roma, viale del Policlinico 155, Roma, Italy
| | - Daniele Armocida
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Mauro Palmieri
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Valerio Di Norcia
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Luca D’Angelo
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Massimo Mongardini
- A.U.O. “Policlinico Umberto I”, Dipartimento di Chirurgia Generale, Sapienza University, Roma, Italy
| | - Massimo Vigliotta
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Edoardo Maccari
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Antonio Santoro
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
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Baldi GG, Lo Vullo S, Grignani G, Vincenzi B, Badalamenti G, Mastore M, Buonomenna C, Morosi C, Barisella M, Frezza AM, Provenzano S, Simeone N, Picozzi F, Mariani L, Casali PG, Stacchiotti S. Weekly cisplatin with or without imatinib in advanced chordoma: A retrospective case-series analysis from the Italian Rare Cancers Network. Cancer 2022; 128:1439-1448. [PMID: 35026050 DOI: 10.1002/cncr.34083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND To report on a retrospective case-series analysis of weekly cisplatin (wCDDP) as a single agent or combined with imatinib (wCDDP/I) in patients with advanced chordoma treated within the Italian Rare Cancer Network. METHODS Adult patients with a diagnosis of advanced, brachyury-positive chordoma, treated from April 2007 to October 2020 with wCDDP or wCDDP/I were retrospectively identified. Imatinib was withheld at the same time as wCDDP. Response according to Response Evaluation Criteria in Solid Tumors, overall survival (OS), and progression-free survival (PFS) were analyzed. RESULTS Thirty-three consecutive patients were identified (wCDDP as front-line n = 8 [24.2%]; wCDDP as a further line n = 25 [75.8%]; prior imatinib n = 25 [75.8%]; evidence of progression before starting wCDDP n = 33). Of 32 patients evaluable for response (wCDDP, n = 22 [68.8%]; wCDDP/I, n = 10 [31.3%]), best response was stable disease (SD) in 27 patients (84.3%) and progression in 5 patients (15.6%). At a median follow-up of 54 months, the median OS (m-OS) was 30.3 months (interquartile range [IQR], 18.1-56.6), the m-PFS was 8.0 months (IQR, 5.1-17.0), the 6-month PFS rate was 65.2%, and the 12-month PFS rate was 30.3%. Of 22 patients who received wCDDP, the best response was SD in 18 patients (81.8%) and progression in 4 patients (18.2%), and the m-PFS was 8.0 months (IQR, 5.1-17.0 months). Of 10 patients who received treatment with wCDDP/I, the best response was SD in 9 patients (90%) and progression in 1 patient (10%), and the m-PFS was 9.3 months (IQR, 4.9-26.5 months). CONCLUSIONS This series suggests that wCDDP, both as a single agent and combined with imatinib, has antitumor activity in chordoma. Although no dimensional responses were observed, 65% and 30% of previously progressive patients were progression-free at 6 and 12 months, respectively. A prospective study is warranted.
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Affiliation(s)
- Giacomo G Baldi
- Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Biomedico University of Rome, Rome, Italy
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological, and Oral Sciences - Section of Medical Oncology, University of Palermo, Palermo, Italy
| | | | - Ciriaco Buonomenna
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Anna Maria Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Provenzano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Noemi Simeone
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fernanda Picozzi
- Deparment of Medical Oncology, Azienda Ospedaliera di Rilievo Nazionale dei Colli Monaldi-Cotugno, Naples, Italy.,Department of Electrical Engineering and Information Technology, Federico II University of Naples, Naples, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo G Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Yolcu YU, Zreik J, Wahood W, Bhatti AUR, Bydon M, Houdek MT, Rose PS, Mahajan A, Petersen IA, Haddock MG, Ahmed SK, Laack NN, Jethwa K, Jeans EB, Imai R, Yamada S, Foote RL. Comparison of Oncologic Outcomes and Treatment-Related Toxicity of Carbon Ion Radiotherapy and En Bloc Resection for Sacral Chordoma. JAMA Netw Open 2022; 5:e2141927. [PMID: 34994795 PMCID: PMC8742192 DOI: 10.1001/jamanetworkopen.2021.41927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Maximal resection is the preferred management for sacral chordomas but can be associated with unacceptable morbidity. Outcomes with radiotherapy are poor. Carbon ion radiotherapy (CIRT) is being explored as an alternative when surgery is not preferred. OBJECTIVE To compare oncologic outcomes and treatment-related toxicity of CIRT and en bloc resection for sacral chordoma. DESIGN, SETTING, AND PARTICIPANTS Univariable logistic regression was performed to evaluate the association between treatment type and oncologic and toxicity outcomes in this retrospective cohort study. Nearest-neighbor propensity score matching was used to match the CIRT cohort with the en bloc resection cohort and 10 National Cancer Database (NCDB) cohorts separately, with the objective of obtaining more homogeneous cohorts when comparing treatments. Patient- and tumor-related characteristics from 2 institutional cohorts were collected for patients diagnosed with sacral chordomas between April 1, 1994, and July 31, 2017. The NCDB was queried for data on patients with sacral chordoma from January 1, 2004, to December 31, 2016, as a comparator in overall survival (OS) analyses. Data analysis was conducted from February 24, 2020, to January 16, 2021. EXPOSURES En bloc resection, incomplete resection, photon radiotherapy, proton radiotherapy, and CIRT. MAIN OUTCOMES AND MEASURES Overall survival was estimated using the Kaplan-Meier method and compared using the Cox proportional hazards model. Peripheral motor nerve toxic effects were scored using Common Terminology Criteria for Adverse Events, version 4.03. RESULTS A total of 911 patients were included in the study (NCDB: n = 669; median age, 64 [IQR, 52-74] years; 410 [61.3%] men; CIRT: n = 188; median age, 66 [IQR, 58-71] years; 128 [68.1%] men; en bloc surgical resection: n = 54; median age, 53.5 [IQR 49-64] years, 36 [66.7%] men). Comparison of the propensity score-matched institutional en bloc resection and CIRT cohorts revealed no statistically significant difference in OS (CIRT: median OS, 68.1 [95% CI, 44.0-102.6] months; en bloc resection: median OS, 58.6 [95% CI, 25.6-123.5] months; P = .57; hazard ratio, 0.71 [95% CI, 0.25-2.06]; P = .53). The CIRT cohort experienced lower rates of peripheral motor neuropathy (odds ratio, 0.13 [95% CI, 0.04-0.40]; P < .001). On comparison of the propensity score-matched NCDB cohorts with the CIRT cohort, significantly higher OS was found for CIRT compared with margin-positive surgery without adjuvant radiotherapy (CIRT: median OS, 64.7 [95% CI, 57.8-69.7] months; margin-positive surgery without adjuvant radiotherapy: median OS, 60.6 [95% CI, 44.2-69.7] months, P = .03) and primary radiotherapy alone (CIRT: median OS, 64.9 [95% CI 57.0-70.5] months; primary radiotherapy alone: 31.8 [95% CI, 27.9-40.6] months; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that CIRT can be used as treatment for older patients with high performance status and sacral chordoma in whom surgery is not preferred. CIRT might provide additional benefit for patients who undergo margin-positive resection or who are candidates for primary photon radiotherapy.
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Affiliation(s)
- Yagiz U Yolcu
- Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jad Zreik
- Central Michigan University College of Medicine, Mount Pleasant
| | - Waseem Wahood
- Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida
| | | | - Mohamad Bydon
- Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Krishan Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Reiko Imai
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Inageku, Chiba, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Inageku, Chiba, Japan
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Yao H, Duan P, Zhu X, Zhong Y, Li X, Wang H, Chou D. Treatment of Benign C2 Tumors with Transoral Curettage and Posterior Instrumentation with Minimum 2-Year Follow-Up: Technical Note. Neurol India 2022; 70:68-73. [DOI: 10.4103/0028-3886.336331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Karampouga M, Tsetsos F, Sakellariou P, Baltas I. Outcomes and issues of 12 chordomas treated in a single center. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chordomas stem from notochordal vestiges and rank as low-grade bone malignancies although fraught with high risk of recurrence. This study assesses the clinical outcomes of twelve chordoma cases treated in our clinic, in an effort to shed light on the often under-represented pool of results deriving from non-referral centers.
Methods
We reviewed the clinicopathological traits of all chordoma patients registered in our center since 1991. Major endpoints were overall survival (OS) and progression-free survival (PFS) estimated using the Kaplan–Meier and Nelson–Aalen methods.
Results
Twelve patients, aged on average 47.9 years, were treated for primary or recurrent disease. Seven had chordomas originating in the cranium, 5 in the spine, including a bifocal tumor, and the mean time lapse between the beginning of symptoms and diagnosis was 15.4 months, marked by dull ache. Subtotal resection was achieved in 5 cases, incomplete in 5, while in 2, only biopsy was accomplished. Conformal radiotherapy was administered to 5 and stereotactic radiosurgery to 2 in the setting of recurrence. Protons were used once and targeted agents induced no clinical response in 3 patients. Median OS and PFS were 36 and 12 months, respectively, with the best outlook linked to maximal resection, spinal location, and good preoperative functional status. In all, 6 patients died of chordoma, 4 are alive, and 1 was lost. Relapse was the rule for most cases, except 2, and pulmonary metastases were ascertained in 1.
Conclusions
Our cases were typical of chordomas, implying that inadequate surgical margins and successive recurrence are negative determinants of prognosis and that interinstitutional cooperation counterbalances shortages in non-referral institutes.
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Chen X, Lo SFL, Bettegowda C, Ryan DM, Gross JM, Hu C, Kleinberg L, Sciubba DM, Redmond KJ. High-dose hypofractionated stereotactic body radiotherapy for spinal chordoma. J Neurosurg Spine 2021; 35:674-683. [PMID: 34388713 DOI: 10.3171/2021.2.spine202199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal chordoma is locally aggressive and has a high rate of recurrence, even after en bloc resection. Conventionally fractionated adjuvant radiation leads to suboptimal tumor control, and data regarding hypofractionated regimens are limited. The authors hypothesized that neoadjuvant stereotactic body radiotherapy (SBRT) may overcome its intrinsic radioresistance, improve surgical margins, and allow preservation of critical structures during surgery. The purpose of this study is to review the feasibility and early outcomes of high-dose hypofractionated SBRT, with a focus on neoadjuvant SBRT. METHODS Electronic medical records of patients with spinal chordoma treated using image-guided SBRT between 2009 and 2019 at a single institution were retrospectively reviewed. RESULTS Twenty-eight patients with 30 discrete lesions (24 in the mobile spine) were included. The median follow-up duration was 20.8 months (range 2.3-126.3 months). The median SBRT dose was 40 Gy (range 15-50 Gy) in 5 fractions (range 1-5 fractions). Seventeen patients (74% of those with newly diagnosed lesions) received neoadjuvant SBRT, of whom 15 (88%) underwent planned en bloc resection, all with negative margins. Two patients (12%) developed surgical wound-related complications after neoadjuvant SBRT and surgery, and 4 (two grade 3 and two grade 2) experienced postoperative complications unrelated to the surgical site. Of the remaining patients with newly diagnosed lesions, 5 received adjuvant SBRT for positive or close surgical margins, and 1 received SBRT alone. Seven recurrent lesions were treated with SBRT alone, including 2 after failure of prior conventional radiation. The 2-year overall survival rate was 92% (95% confidence interval [CI] 71%-98%). Patients with newly diagnosed chordoma had longer median survival (not reached) than those with recurrent lesions (27.7 months, p = 0.006). The 2-year local control rate was 96% (95% CI 74%-99%). Among patients with radiotherapy-naïve lesions, no local recurrence was observed with a biologically effective dose ≥ 140 Gy, maximum dose of the planning target volume (PTV) ≥ 47 Gy, mean dose of the PTV ≥ 39 Gy, or minimum dose to 80% of the PTV ≥ 36 Gy (5-fraction equivalent doses). All acute toxicities from SBRT were grade 1-2, and no myelopathy was observed. CONCLUSIONS Neoadjuvant high-dose, hypofractionated SBRT for spinal chordoma is safe and does not increase surgical morbidities. Early outcomes at 2 years are promising, although long-term follow-up is pending.
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Affiliation(s)
- Xuguang Chen
- Departments of1Radiation Oncology and Molecular Radiation Sciences
| | | | | | | | - John M Gross
- 4Pathology, Johns Hopkins University School of Medicine; and
| | - Chen Hu
- 5Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Baldassarre BM, Di Perna G, Portonero I, Penner F, Cofano F, Marco RD, Marengo N, Garbossa D, Pecorari G, Zenga F. Craniovertebral junction chordomas: Case series and strategies to overcome the surgical challenge. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:420-431. [PMID: 35068826 PMCID: PMC8740819 DOI: 10.4103/jcvjs.jcvjs_87_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/28/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: Chordomas are rare and malignant primary bone tumors. Different strategies have been proposed for chordomas involving the craniovertebral junction (CVJ) compared to other locations. The impossibility to achieve en bloc excision, the impact on stability and the need for proper reconstruction make their surgical management challenging. Objective: The objective is to discuss surgical strategies in CVJ chordomas operated in a single-center during a 7 years' experience (2013-2019). Methods: Adult patients with CVJ chordoma were retrospectively analyzed. The clinical, radiological, pathological, and surgical data were discussed. Results: A total number of 8 patients was included (among a total number of 32 patients suffering from skull base chordoma). Seven patients underwent endoscopic endonasal approach (EEA), and posterior instrumentation was needed in three cases. Three explicative cases were reported: EEA for midline tumor involving lower clivus and upper cervical spine (case 1), EEA and complemental posterior approach for occurred occipitocervical instability (case 2), C2 chordoma which required aggressive bone removal and consequent implant positioning, focusing on surgical planning (timing and type of surgical stages, materials and customization of fixation system) (case 3). Conclusion: EEA could represent a safe route to avoid injuries to neurovascular structure in clival locations, while a combined approach could be considered when tumor spreads laterally. Tumor involvement or surgical procedures could give raise to CVJ instability with the need of complementary posterior instrumentation. Thus, a tailored preoperative planning should play a key role, especially when aggressive bone removal and implant positioning are needed.
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Affiliation(s)
- Bianca Maria Baldassarre
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Irene Portonero
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Federica Penner
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy.,Spine Surgery Unit, Humanitas Cellini Hospital, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy.,Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Raffaele De Marco
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Nicola Marengo
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Giancarlo Pecorari
- Department of Surgical Sciences, ENT Surgery Unit, University of Turin, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
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Chander VS, Govindasamy R, Tukkapuram VR, Gopal S, Rudrappa S. Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center's Experience and Literature Review. Asian Spine J 2021; 16:567-582. [PMID: 34551502 PMCID: PMC9441426 DOI: 10.31616/asj.2021.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
Sacral tumors are rare and can be benign or malignant. Their management is multifactorial and is based on the pathology, extent, and local and distant spread. Managing sacral tumors is challenging due to their proximity to visceral and neural structures. Surgical wide excision has been the standard of care for aggressive benign and malignant tumors. Our purpose was to evaluate the outcomes of a multimodal approach to managing primary sacral tumors in Sakra World Hospital, a tertiary spine care center in Bengaluru, India and perform a literature review to determine a workflow pathway. Our study was a retrospective review of patient records and included 15 patients with primary sacral tumors. Eleven surgically treated patients were evaluated clinically and radiologically and underwent biopsy before surgical excision by an all-posterior approach. A multidisciplinary approach that included intraoperative neural monitoring, plastic reconstruction, adjuvant chemotherapy, and radiotherapy was implemented whenever necessary. Sacral root preservation was attempted whenever feasible. Functional outcomes (based on the Visual Analog Scale [VAS] and Biagini scoring system) were analyzed along with disease control, with a minimum of 2 years of follow-up. The mean follow-up was 29±9.8 months. The mean VAS score significantly improved from 7.8±2.6 to 3.7±3.8 (p=0.026). Bowel function showed statistically significant improvement, from a mean score of 0.81±0.47 to 0.63±0.52 (p=0.026) at 2 years of follow-up. The mean pretreatment motor and bladder function scores were 0.53±0.31 and 0.74±0.44, respectively, improving to 0.48±0.33 and 0.68±0.56 at follow-up but without statistical significance. There was no significant loss of function, which is expected in radical sacral resections. In conclusion, primary sacral tumors require a multidisciplinary approach and management for optimal outcomes. A stand-alone posterior approach can be employed to treat most sacral lesions. En-bloc wide resection is the optimal treatment for primary malignant and aggressive benign tumors. Preservation of at least one functional S2 nerve root is imperative to preserve bowel and bladder function.
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Affiliation(s)
- Venugopal Sarath Chander
- Institute of Neurosciences, Sakra World Hospital, Bangalore, India.,Department of Spine Surgery, Sakra World Hospital, Bangalore, India
| | - Ramachandran Govindasamy
- Institute of Neurosciences, Sakra World Hospital, Bangalore, India.,Department of Spine Surgery, Sakra World Hospital, Bangalore, India
| | - Venkata Ramakrishna Tukkapuram
- Institute of Neurosciences, Sakra World Hospital, Bangalore, India.,Department of Spine Surgery, Sakra World Hospital, Bangalore, India
| | - Swaroop Gopal
- Institute of Neurosciences, Sakra World Hospital, Bangalore, India.,Department of Spine Surgery, Sakra World Hospital, Bangalore, India
| | - Satish Rudrappa
- Institute of Neurosciences, Sakra World Hospital, Bangalore, India.,Department of Spine Surgery, Sakra World Hospital, Bangalore, India
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Baig Mirza A, Bartram J, Okasha M, Al Banna Q, Vastani A, Maratos E, Gullan R, Thomas N. Surgical Management of Spinal Chordoma: A Systematic Review and Single-Center Experience. World Neurosurg 2021; 156:e111-e129. [PMID: 34506978 DOI: 10.1016/j.wneu.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. The importance of wide margins and use of adjuvant therapy in spinal chordomas are still contentious points in the management of spinal chordomas. We conducted a systematic review of the surgical management of spinal chordomas alongside our 10-year institutional experience. METHODS A systematic search of the literature was performed in November 2020 using Embase and MEDLINE for articles regarding the surgical management of chordomas arising from the mobile spine and sacrum. We also searched for all adult patients who were surgically managed for spinal chordomas at our institute between 2010 and 2020. In both the systematic review and our institutional case series, data on adequacy of resection, use of adjuvant therapy, complications, recurrence (local or metastatic), and survival outcomes were collected. RESULTS We identified and analyzed 42 articles, yielding 1531 patients, from which the overall gross total or wide resection rate was 54.9%. Among the 8 cases in our institutional experience (4 sacral, 3 cervical, and 1 lumbar), we achieved gross total resection in 50% of initial operations. The recurrence rate was 25% in our gross total resection group and 50% where initial resection was subtotal. Of patients, 75% had no evidence of recurrence at most recent follow-up. CONCLUSIONS Albeit difficult at times because of the proximity to neurovascular tissue, achieving a wide resection followed by adjuvant therapy for spinal chordomas is of great importance. Multidisciplinary discussion is valuable to ensure the best outcome for the patient.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mohamed Okasha
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Qusai Al Banna
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Eleni Maratos
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Burke JF, Chan AK, Mayer RR, Garcia JH, Pennicooke B, Mann M, Berven SH, Chou D, Mummaneni PV. Clamshell thoracotomy for en bloc resection of a 3-level thoracic chordoma: technical note and operative video. Neurosurg Focus 2021; 49:E16. [PMID: 32871571 DOI: 10.3171/2020.6.focus20382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
The clamshell thoracotomy is often used to access both hemithoraxes and the mediastinum simultaneously for cardiothoracic pathology, but this technique is rarely used for the excision of spinal tumors. We describe the use of a clamshell thoracotomy for en bloc excision of a 3-level upper thoracic chordoma in a 20-year-old patient. The lesion involved T2, T3, and T4, and it invaded both chest cavities and indented the mediastinum. After 2 biopsies to confirm the diagnosis, the patient underwent a posterior spinal fusion followed by bilateral clamshell thoracotomy for 3-level en bloc resection with simultaneous access to both chest cavities and the mediastinum. To demonstrate how the clamshell thoracotomy was used to facilitate the tumor resection, an operative video and illustrations are provided, which show in detail how the clamshell thoracotomy can be used to access both hemithoraxes and the mediastinum.
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Affiliation(s)
| | | | | | | | | | - Michael Mann
- 3Department of Surgery, Division of Adult Cardiothoracic Surgery, and
| | - Sigurd H Berven
- 4Department of Orthopedic Surgery, University of California, San Francisco, California
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