1
|
Goumenos S, Kakouratos G, Trikoupis I, Gavriil P, Gerasimidis P, Soultanis K, Patapis P, Kontogeorgakos V, Papagelopoulos P. Clinical Outcome after Surgical Treatment of Sacral Chordomas: A Single-Center Retrospective Cohort of 27 Patients. Cancers (Basel) 2024; 16:973. [PMID: 38473334 DOI: 10.3390/cancers16050973] [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: 01/15/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: The aims of our study were (1) to determine disease-specific and disease-free survival after the en-bloc resection of sacral chordomas and (2) to investigate potential risk factors for tumor recurrence and major postoperative wound-related complications. Methods: We retrospectively analyzed 27 consecutive patients with sacral chordomas who were surgically treated in our institution between 2004 and 2022. Three patients (11.1%) had a recurrent tumor and four patients (14.8%) had history of a second primary solid tumor prior to or after their sacral chordoma. A combined anterior and posterior approach, colostomy, plastic reconstruction, and spinopelvic instrumentation were necessitated in 51.9%, 29.6%, 37%, and 7.4% of cases, respectively. The mean duration of follow-up was 58 ± 41 months (range= 12-170). Death-related-to-disease, disease recurrence, and major surgical site complications were analyzed using Kaplan-Meier survival analysis, and investigation of the respective risk factors was performed with Cox hazard regression. Results: The estimated 5-year and 10-year disease-specific survival was 75.3% (95% CI = 49.1-87.5%) and 52.7% (95% CI = 31-73.8%), respectively. The estimated 1-year, 5-year, and 10-year disease-free survival regarding local and distant disease recurrence was 80.4% (95% CI = 60.9-91.1%), 53.9% (95% CI = 24.6-66.3%), and 38.5% (95% CI = 16.3-56.2%), respectively. The mean survival of the recurred patients was 61.7 ± 33.4 months after their tumor resection surgery. Conclusions: Despite the high relapse rates and perioperative morbidity, long-term patient survival is not severely impaired. Positive or less than 2 mm negative resection margins have a significant association with disease progression.
Collapse
Affiliation(s)
- Stavros Goumenos
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Georgios Kakouratos
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Ioannis Trikoupis
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Panagiotis Gavriil
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Pavlos Gerasimidis
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Konstantinos Soultanis
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Pavlos Patapis
- 3rd Department of Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Vasileios Kontogeorgakos
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| | - Panayiotis Papagelopoulos
- 1st Department of Orthopaedic Surgery, "Attikon" University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
- John Pham
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Miao Z, Xu M, Zheng K, Gong H, Yan N, Chen Q, Yu X. Denosumab combined with precision radiotherapy for recurrent giant cell tumor of the thoracic spine: a case report and literature review. Front Neurol 2024; 14:1308600. [PMID: 38239323 PMCID: PMC10794628 DOI: 10.3389/fneur.2023.1308600] [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: 10/06/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Giant cell tumors of the spine have a high recurrence rate owing to their special anatomical site; hence, further treatment after recurrence is very challenging. Achieving effective tumor control and improving the long-term quality of life of the patients are the main treatment purposes to consider for recurrent giant cell tumors of the spine. A patient showing giant cell tumor recurrence of the thoracic spine after curettage received denosumab combined with precision radiotherapy, through which the tumor gained good control and the patient could regain normal functioning. A review of the relevant literature suggested that denosumab combined with radiotherapy is an effective new approach for the treatment of recurrent giant cell tumors of the spine.
Collapse
Affiliation(s)
- Zukang Miao
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ming Xu
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Kai Zheng
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Hai Gong
- Department of Radiotherapy, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Ning Yan
- Department of Radiotherapy, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Qian Chen
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Xiuchun Yu
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| |
Collapse
|
4
|
Yeung CM, Bilsky M, Boland PJ, Vaynrub M. The Role of En Bloc Resection in the Modern Era for Primary Spine Tumors. Spine (Phila Pa 1976) 2024; 49:46-57. [PMID: 37732462 PMCID: PMC10750970 DOI: 10.1097/brs.0000000000004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/27/2023] [Indexed: 09/22/2023]
Abstract
STUDY DESIGN A literature review. OBJECTIVE The aim of this review is to provide an overview of benign and malignant primary spine tumors and a balanced analysis of the benefits and limitations of (and alternatives to) surgical treatment with en bloc resection. SUMMARY OF BACKGROUND DATA Primary spine tumors are rare but have the potential to cause severe morbidity, either from the disease itself or as a result of treatment. The prognosis, goals, and treatment options vary significantly with the specific disease entity. Appropriate initial management is critical; inappropriate surgery before definitive treatment can lead to recurrence and may render the patient incurable, as salvage options are often inferior. METHODS We performed a comprehensive search of the PubMed database for articles relevant to primary spine neoplasms and en bloc spine surgery. Institutional review board approval was not needed. RESULTS Although Enneking-appropriate en bloc surgery can be highly morbid, it often provides the greatest chance for local control and/or patient survival. However, there is growing data to support modern radiotherapy as a feasible and less morbid approach to certain primary neoplasms that historically were considered radioresistant. CONCLUSIONS Choosing the optimal approach to primary spine tumors is complex. A comprehensive and up-to-date assessment of the evidence is required to guide patient care and to balance the often-competing goals of prolonging life and preserving quality of life.
Collapse
Affiliation(s)
- Caleb M. Yeung
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Patrick J. Boland
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Max Vaynrub
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
5
|
Reyes M, Kayne A, Collopy S, Prashant G, Kelly P, Evans JJ. Multifocal Ectopic Recurrence of a C2 Chordoma. J Neurol Surg Rep 2023; 84:e146-e155. [PMID: 38026145 PMCID: PMC10673705 DOI: 10.1055/s-0043-1777073] [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: 01/24/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background Chordomas are histologically benign but locally aggressive tumors with a high propensity to recur. Our case highlights the importance of long-term vigilance in patients who have undergone chordoma resection. Case Report We report the case of a 47-year-old man with a cervical chordoma who developed multiple musculoskeletal ectopic recurrences in the left supraclavicular region, the proximal right bicep, and the left submandibular region without recurrence in the primary tumor site. Primary tumor resection was achieved via a combination of surgery, adjuvant radiation therapy, and imatinib. All recurrences were successfully resected and confirmed via pathology to be ectopic chordoma. Discussion Ectopic recurrence of cervical chordoma is rare and lung is the most common site of distant spread. Chordoma recurrence in skeletal muscle is particularly rare, with only 10 cases described in the literature. A plausible mechanism of distant metastatic disease in chordoma patients suggests that tumor cells escape the surgical tract via a combination of cytokine release, vasodilation, and microtrauma induced during resection. Conclusion Cervical chordoma with ectopic recurrence in skeletal muscle has not been previously described in the literature. Skull base surgeons should be aware of the phenomenon of chordoma ectopic recurrence in the absence of local recurrence.
Collapse
Affiliation(s)
- Maikerly Reyes
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Allison Kayne
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Sarah Collopy
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Giyarpuram Prashant
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Patrick Kelly
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - James J. Evans
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| |
Collapse
|
6
|
Redmond KJ, Schaub SK, Lo SFL, Khan M, Lubelski D, Bilsky M, Yamada Y, Fehlings M, Gogineni E, Vajkoczy P, Ringel F, Meyer B, Amin AG, Combs SE, Lo SS. Radiotherapy for Mobile Spine and Sacral Chordoma: A Critical Review and Practical Guide from the Spine Tumor Academy. Cancers (Basel) 2023; 15:cancers15082359. [PMID: 37190287 DOI: 10.3390/cancers15082359] [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: 01/10/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
Chordomas are rare tumors of the embryologic spinal cord remnant. They are locally aggressive and typically managed with surgery and either adjuvant or neoadjuvant radiation therapy. However, there is great variability in practice patterns including radiation type and fractionation regimen, and limited high-level data to drive decision making. The purpose of this manuscript was to summarize the current literature specific to radiotherapy in the management of spine and sacral chordoma and to provide practice recommendations on behalf of the Spine Tumor Academy. A systematic review of the literature was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach. Medline and Embase databases were utilized. The primary outcome measure was the rate of local control. A detailed review and interpretation of eligible studies is provided in the manuscript tables and text. Recommendations were defined as follows: (1) consensus: approved by >75% of experts; (2) predominant: approved by >50% of experts; (3) controversial: not approved by a majority of experts. Expert consensus supports dose escalation as critical in optimizing local control following radiation therapy for chordoma. In addition, comprehensive target volumes including sites of potential microscopic involvement improve local control compared with focal targets. Level I and high-quality multi-institutional data comparing treatment modalities, sequencing of radiation and surgery, and dose/fractionation schedules are needed to optimize patient outcomes in this locally aggressive malignancy.
Collapse
Affiliation(s)
- Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - Stephanie K Schaub
- Department of Radiation Oncology, The University of Washington, Seattle, WA 98195, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY 11549, USA
| | - Majid Khan
- Department of Radiology, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - Daniel Lubelski
- Department of Neurological Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Michael Fehlings
- Department of Neurosurgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University, Columbus, OH 43210, USA
| | - Peter Vajkoczy
- Department of Neurosurgery, Charite University Hospital, 10117 Berlin, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, 80333 Munich, Germany
| | - Anubhav G Amin
- Department of Neurological Surgery, University of Washington, Seattle, WA 98115, USA
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, 81675 Munich, Germany
| | - Simon S Lo
- Department of Radiation Oncology, The University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Disch AC, Boriani S, Luzzati A, Rhines LD, Fisher CG, Lazary A, Gokaslan ZL, Chou D, Clarke MJ, Fehlings MG, Schaser KD, Germscheid NM, Reynolds JJ. Extradural Primary Malignant Spinal Tumors in a Population Younger than 25 Years: An Ambispective International Multicenter Study on Onco-Surgical Outcomes. Cancers (Basel) 2023; 15:cancers15030845. [PMID: 36765803 PMCID: PMC9913243 DOI: 10.3390/cancers15030845] [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: 12/30/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Extradural malignant primary spinal tumors are rare and outcome data, especially for younger patients, is limited. In a worldwide (11 centers) study (Predictors of Mortality and Morbidity in the Surgical Management of Primary Tumors of the Spine study; ClinicalTrials.gov Identifier NCT01643174) by the AO Spine Knowledge Forum Tumor, patients surgically treated for primary tumors of the spine between 1992 and 2012, were retrospectively analyzed from a prospective database of their medical history. Medical history, tumor characteristics, diagnostics, treatments, cross-sectional survival, and local recurrences were analyzed. Sixty-eight cases (32 f; 36 m), at an average age of 18.6 ± 4.7 years at the time of diagnosis, were identified (median follow-up 2.9 years). The most common entities were Ewing's sarcoma (42.6%). Of the patients, 28% had undergone previous spine tumor surgery in another center (84% with intralesional margins). Resection was considered "Enneking appropriate" (EA) in 47.8% of the cases. Of the patients, 77.9% underwent chemotherapy and 50% radiotherapy. A local recurrence occurred in 36.4%. Over a third of patients died within a 10-year follow-up period. Kaplan-Meier-analysis demonstrated statistically significant overall survival (p = 0.007) and local recurrence rates (p = 0.042) for tumors treated with EA surgery versus Enneking inappropriate surgery. Aggressive resection of extradural primary malignant spinal tumors combined with adjuvant therapy reveals low local recurrence rates and better outcomes overall in younger patients.
Collapse
Affiliation(s)
- Alexander C. Disch
- University Center for Orthopedics, Trauma & Plastic Surgery, University Comprehensive Spine Center (UCSC), University Hospital Carl Gustav Carus Dresden at the TU Dresden, 01307 Dresden, Germany
- Correspondence:
| | | | | | - Laurence D. Rhines
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles G. Fisher
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Aron Lazary
- National Center for Spinal Disorders, 1126 Budapest, Hungary
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI 02903, USA
| | - Dean Chou
- Department of Neurosurgery, The UCSF Spine Center, University of California, San Francisco, CA 94143, USA
| | | | - Michael G. Fehlings
- Department of Surgery Halbert Chair, Spinal Program University of Toronto, Toronto Western Hospital University Health Network, Toronto, ON M5T 2S8, Canada
| | - Klaus-Dieter Schaser
- University Center for Orthopedics, Trauma & Plastic Surgery, University Comprehensive Spine Center (UCSC), University Hospital Carl Gustav Carus Dresden at the TU Dresden, 01307 Dresden, Germany
| | | | - Jeremy J. Reynolds
- Oxford Spinal Surgery Unit, Oxford University Hospitals, Oxford OX3 7LE, UK
| | | |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Andrew Jae-Min Park
- Department of Orthopedic Surgery and Physical Performance, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | | | | |
Collapse
|
11
|
Rose PS. The management of sacral tumours. Bone Joint J 2022; 104-B:1284-1291. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0734.r1] [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] [Indexed: 12/03/2022]
Abstract
Tumours of the sacrum are difficult to manage. The sacrum provides the structural connection between the torso and lower half of the body and is subject to both axial and rotational forces. Thus, tumours or their treatment can compromise the stability of the spinopelvic junction. Additionally, nerves responsible for lower limb motor groups as well as bowel, bladder, and sexual function traverse or abut the sacrum. Preservation or sacrifice of these nerves in the treatment of sacral tumours has profound implications on the function and quality of life of the patient. This annotation will discuss current treatment protocols for sacral tumours. Cite this article: Bone Joint J 2022;104-B(12):1284–1291.
Collapse
Affiliation(s)
- Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Journal of the American Academy of Orthopaedic Surgeons, Rosemont, Illinois, USA
| |
Collapse
|
12
|
Mellert K, Seeling C, Möller P, Barth TFE. [Chordoma-An update]. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:50-55. [PMID: 36175666 DOI: 10.1007/s00292-022-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Chordomas are rare malignant tumors of the axial skeleton with notochordal differentiation. From a morphological point of view, chordomas display a broad spectrum ranging from the classical, conventional form not otherwise specified (NOS) to forms with hepatoid or renal carcinoma-like differentiation or even poorly or dedifferentiated variants. The detection of brachyury is highly characteristic, though not exclusive. The morphological differential diagnosis from a benign notochordal tumor (BNCT) requires integration of imaging since BNCT is limited to the vertebral bodies and is not osteolytic. Targeted therapy is a current research focus and cell lines as in vitro models are a precondition for the establishment and validation of this approach.
Collapse
Affiliation(s)
- K Mellert
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Deutschland
| | - C Seeling
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Deutschland
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Deutschland
| | - T F E Barth
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Deutschland.
| |
Collapse
|
13
|
Court C, Briand S, Mir O, Le Péchoux C, Lazure T, Missenard G, Bouthors C. Management of chordoma of the sacrum and mobile spine. Orthop Traumatol Surg Res 2022; 108:103169. [PMID: 34890865 DOI: 10.1016/j.otsr.2021.103169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/03/2023]
Abstract
Chordoma is a very rare, poorly known malignancy, with slow progression, mainly located in the sacrum and spine. All age groups may be affected, with a diagnostic peak in the 5th decade of life. Clinical diagnosis is often late. Histologic diagnosis is necessary, based on percutaneous biopsy. Specific markers enable diagnosis and prediction of response to novel treatments. New radiation therapy techniques can stabilize the tumor for 5 years in inoperable patients, but en-bloc resection is the most effective treatment, and should be decided on after a multidisciplinary oncology team meeting in an expert reference center. The type of resection is determined by fine analysis of invasion. According to the level of resection, the patients should be informed and prepared for the expected vesico-genito-sphincteral neurologic sequelae. In tumors not extending above S3, isolated posterior resection is possible. Above S3, a double approach is needed. Anterior release of the sacrum is performed laparoscopically or by robot; resection uses a posterior approach. Posterior wall reconstruction is performed, with an associated flap. Spinopelvic stabilization is necessary in trans-S1 resection. Total or partial sacrectomy shows high rates of complications: intraoperative blood loss, infection or mechanical issues. Neurologic sequelae depend on the level of root sacrifice. No genital-sphincteral function survives S3 root sacrifice. Patient survival depends on initial resection quality and the center's experience. Immunotherapy is an ongoing line of research.
Collapse
Affiliation(s)
- Charles Court
- Service d'Orthopédie et Traumatologie de l'Hôpital de Bicêtre, Université Paris-Saclay, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France.
| | - Sylvain Briand
- Service d'Orthopédie et Traumatologie de l'Hôpital de Bicêtre, Université Paris-Saclay, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - Olivier Mir
- Service d'Oncologie, Institut Gustave Roussy, Université Paris Saclay, 114, rue Edouard-Vaillant, 94805 Villejuif Cedex, France
| | - Cécile Le Péchoux
- Service d'Oncologie, Institut Gustave Roussy, Université Paris Saclay, 114, rue Edouard-Vaillant, 94805 Villejuif Cedex, France
| | - Thierry Lazure
- Service d'Anatomopathologie de l'Hôpital de Bicêtre, Université Paris Saclay, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - Gilles Missenard
- Service d'Orthopédie et Traumatologie de l'Hôpital de Bicêtre, Université Paris-Saclay, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - Charlie Bouthors
- Service d'Orthopédie et Traumatologie de l'Hôpital de Bicêtre, Université Paris-Saclay, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| |
Collapse
|
14
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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
| |
Collapse
|
15
|
Yuan W, Wei F, Ouyang H, Ren X, Hang J, Mo X, Liu Z. CMTM3 suppresses chordoma progress through EGFR/STAT3 regulated EMT and TP53 signaling pathway. Cancer Cell Int 2021; 21:510. [PMID: 34560882 PMCID: PMC8461898 DOI: 10.1186/s12935-021-02159-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/18/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Chordomas are rare, slow-growing and locally aggressive bone sarcomas. At present, chordomas are difficult to manage due to their high recurrence rate, metastasis tendency and poor prognosis. The underlying mechanisms of chordoma tumorigenesis and progression urgently need to be explored to find the effective therapeutic targets. Our previous data demonstrates that EGFR plays important roles in chordoma development and CKLF-like MARVEL transmembrane domain containing (CMTM)3 suppresses gastric cancer metastasis by inhibiting the EGFR/STAT3/EMT signaling pathway. However, the roles and mechanism of CMTM3 in chordomas remain unknown. METHODS Primary chordoma tissues and the paired adjacent non-tumor tissues were collected to examine the expression of CMTM3 by western blot. The expression of CMTM3 in chordoma cell lines was tested by Real-time PCR and western blot. CCK-8 and colony forming unit assay were performed to delineate the roles of CMTM3 in cell proliferation. Wound healing and Transwell assays were performed to assess cell migration and invasion abilities. A xenograft model in NSG mice was used to elucidate the function of CMTM3 in vivo. Signaling pathways were analyzed by western blot and IHC. RNA-seq was performed to further explore the mechanism regulated by CMTM3 in chordoma cells. RESULTS CMTM3 expression was downregulated in chordoma tissues compared with paired normal tissues. CMTM3 suppressed proliferation, migration and invasion of chordoma cells in vitro and inhibited tumor growth in vivo. CMTM3 accelerated EGFR degradation, suppressed EGFR/STAT3/EMT signaling pathway, upregulated TP53 expression and enriched the TP53 signaling pathway in chordoma cells. CONCLUSIONS CMTM3 inhibited tumorigenesis and development of chordomas through activating the TP53 signaling pathway and suppressing the EGFR/STAT3 signaling pathway, which suppressed EMT progression. CMTM3 might be a potential therapeutic target for chordomas.
Collapse
Affiliation(s)
- Wanqiong Yuan
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Xiaoqing Ren
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China
| | - Jing Hang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Beijing, China. .,Peking University Third Hospital, Key Laboratory of Assisted Reproduction, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China.
| | - Xiaoning Mo
- Department of Immunology, Key Laboratory of Medical Immunology, Ministry of Health, School of Basic Medical Sciences, Peking University Center for Human Disease Genomics, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Beijing Key Laboratory of Spinal Disease, Beijing, China. .,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
| |
Collapse
|
16
|
Ni M. [Update and interpretation of 2021 National Comprehensive Cancer Network (NCCN) "Clinical Practice Guidelines for Bone Tumors"]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1186-1191. [PMID: 34523287 DOI: 10.7507/1002-1892.202103073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The incidence of primary malignant bone tumors is low, and clinical cognition is insufficient. The establishment of diagnostic criteria is of great significance for prognosis of tumors. National Comprehensive Cancer Network (NCCN) regularly publishes "Clinical Practice Guidelines for Bone Tumors" to summarize the latest treatment progress of bone tumors. In the latest version of the guidelines released in November 2020, surgery is the main treatment for chondrosarcoma, chordoma, and giant cell tumor of bone, which can be combined with radiotherapy or targeted therapy. Ewing's sarcoma and osteosarcoma are treated by surgery combined with chemotherapy. Immunotherapy can be used to treat high-grade undifferentiated pleomorphic sarcoma. For recurrent tumors, surgery combined with radiotherapy, chemotherapy, and/or targeted therapy can be used for control. The guidelines provide a reference for the standard treatment of bone tumors.
Collapse
Affiliation(s)
- Ming Ni
- Department of Orthopaedics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, 201299, P.R.China
| |
Collapse
|
17
|
Massaad E, Shankar GM, Shin JH. Novel Applications of Spinal Navigation in Deformity and Oncology Surgery-Beyond Screw Placement. Oper Neurosurg (Hagerstown) 2021; 21:S23-S38. [PMID: 34128068 DOI: 10.1093/ons/opaa322] [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: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Computer-assisted navigation has made a major impact on spine surgery, providing surgeons with technological tools to safely place instrumentation anywhere in the spinal column. With advances in intraoperative image acquisition, registration, and processing, many surgeons are now using navigation in their practices. The incorporation of navigation into the workflow of surgeons continues to expand with the evolution of minimally invasive techniques and robotic surgery. While numerous investigators have demonstrated the benefit of navigation for improving the accuracy of instrumentation, few have reported applying this technology to other aspects of spine surgery. Surgeries to correct spinal deformities and resect spinal tumors are technically demanding, incorporating a wide range of techniques not only for instrumentation placement but also for osteotomy planning and executing the goals of surgery. Although these subspecialties vary in their objectives, they share similar challenges with potentially high complications, invasiveness, and consequences of failed execution. Herein, we highlight the utility of using spinal navigation for applications beyond screw placement: specifically, for planning and executing osteotomies and guiding the extent of tumor resection. A narrative review of the work that has been done is supplemented with illustrative cases demonstrating these applications.
Collapse
Affiliation(s)
- Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Passer JZ, Alvarez-Breckenridge C, Rhines L, DeMonte F, Tatsui C, Raza SM. Surgical Management of Skull Base and Spine Chordomas. Curr Treat Options Oncol 2021; 22:40. [PMID: 33743089 DOI: 10.1007/s11864-021-00838-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/22/2022]
Abstract
OPINION STATEMENT Management of chordoma along the cranial-spinal axis is a major challenge for both skull base and spinal surgeons. Although chordoma remains a rare tumor, occurring in approximately 1 per 1 million individuals, its treatment poses several challenges. These tumors are generally poorly responsive to radiation and chemotherapy, leading to surgical resection as the mainstay of treatment. Due to anatomic constraints and unique challenges associated with each primary site of disease, gross total resection is often not feasible and is associated with high rates of morbidity. Additionally, chordoma is associated with high rates of recurrence due to the tumor's aggressive biologic features, and postoperative radiation is increasingly incorporated as a treatment option for these patients. Despite these challenges, modern-day surgical techniques in both skull base and spinal surgery have facilitated improved patient outcomes. For example, endoscopic endonasal techniques have become the mainstay in resection of skull base chordomas, improving the ability to achieve gross total resection, while reducing associated morbidity of open transfacial techniques. Resection of spinal chordomas has been facilitated by emerging techniques in preoperative imaging, intraoperative navigation, spinal reconstruction, and radiotherapy. Taken collectively, the treatment of chordoma affecting the skull base and spinal requires a multidisciplinary team of surgeons, radiation oncologists, and medical oncologists who specialize in the treatment of this challenging disease.
Collapse
Affiliation(s)
- Joel Z Passer
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Christopher Alvarez-Breckenridge
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Laurence Rhines
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Claudio Tatsui
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Shaan M Raza
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA.
| |
Collapse
|
19
|
Li Z, Lu M. Presacral Tumor: Insights From a Decade's Experience of This Rare and Diverse Disease. Front Oncol 2021; 11:639028. [PMID: 33796466 PMCID: PMC8008122 DOI: 10.3389/fonc.2021.639028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Presacral tumors are a group of rare and heterogeneous tumors that arise from the potential presacral space between the rectum and sacrum. The low occurrence and diverse origins make the diagnosis and treatment of these tumors a challenge. The aim of the study was to retrospectively review patient demographics and to identify advantages and disadvantages in the diagnosis and treatment of these tumors. Methods Retrospectively collected and reviewed data from patients who received treatment of presacral tumors at the First Affiliated Hospital of China Medical University between August 2009 and June 2019. Results The data from forty-four patients (33 females) with a median age of 50 years who were diagnosed with a presacral/retrorectal tumor were analyzed. The majority of tumors were congenital (61.4%) and benign tumors are more common (59.1%). The median age of patients with benign tumor was significantly higher than that of malignant tumor. The most common symptoms were sacrococcygeal/perianal pain (56.8%) and mass (36.4%), and 8 out of 9 patients having lower limb symptoms diagnosed with malignant tumor. The tumor detection rate of digital rectal examination was 75% and more than 90% of all patients underwent one or more radiology imaging exams for tumor diagnosis. Every patient had a biopsy result. The most common type of tumor was presacral cyst (40.9%) with overall tumor median size of 5.6 cm. Thirty-one (70.5%) patients underwent surgery, most often via the posterior route (83.9%). Posterior route surgery had significantly shorter operation time and tumors operated via posterior route were significantly smaller. The survival rate after surgery was 100%. The median course of disease was 6 months and median follow-up was 25 months. Conclusions Presacral tumors have low occurrence and are more frequently observed in females in their 30s and 50s indicating a possible link between tumor occurrence and hormonal changes. Patients with lower limb symptoms were more likely to have a malignant presacral tumor. Posterior route was the most commonly utilized surgical approach. Supplementary iodine tincture treatment of cysts ruptured in operation could potentially be helpful in reducing the chance of recurrence.
Collapse
Affiliation(s)
- Zeyu Li
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.,Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Lu
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| |
Collapse
|
20
|
Barber SM, Sadrameli SS, Lee JJ, Fridley JS, Teh BS, Oyelese AA, Telfeian AE, Gokaslan ZL. Chordoma-Current Understanding and Modern Treatment Paradigms. J Clin Med 2021; 10:jcm10051054. [PMID: 33806339 PMCID: PMC7961966 DOI: 10.3390/jcm10051054] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022] Open
Abstract
Chordoma is a low-grade notochordal tumor of the skull base, mobile spine and sacrum which behaves malignantly and confers a poor prognosis despite indolent growth patterns. These tumors often present late in the disease course, tend to encapsulate adjacent neurovascular anatomy, seed resection cavities, recur locally and respond poorly to radiotherapy and conventional chemotherapy, all of which make chordomas challenging to treat. Extent of surgical resection and adequacy of surgical margins are the most important prognostic factors and thus patients with chordoma should be cared for by a highly experienced, multi-disciplinary surgical team in a quaternary center. Ongoing research into the molecular pathophysiology of chordoma has led to the discovery of several pathways that may serve as potential targets for molecular therapy, including a multitude of receptor tyrosine kinases (e.g., platelet-derived growth factor receptor [PDGFR], epidermal growth factor receptor [EGFR]), downstream cascades (e.g., phosphoinositide 3-kinase [PI3K]/protein kinase B [Akt]/mechanistic target of rapamycin [mTOR]), brachyury—a transcription factor expressed ubiquitously in chordoma but not in other tissues—and the fibroblast growth factor [FGF]/mitogen-activated protein kinase kinase [MEK]/extracellular signal-regulated kinase [ERK] pathway. In this review article, the pathophysiology, diagnosis and modern treatment paradigms of chordoma will be discussed with an emphasis on the ongoing research and advances in the field that may lead to improved outcomes for patients with this challenging disease.
Collapse
Affiliation(s)
- Sean M. Barber
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Saeed S. Sadrameli
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Jonathan J. Lee
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Jared S. Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Adetokunbo A. Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
- Correspondence: ; Tel.: +1-(401)-793-9132
| |
Collapse
|
21
|
Pennington Z, Ehresman J, McCarthy EF, Ahmed AK, Pittman PD, Lubelski D, Goodwin CR, Sciubba DM. Chordoma of the sacrum and mobile spine: a narrative review. Spine J 2021; 21:500-517. [PMID: 33589095 DOI: 10.1016/j.spinee.2020.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.
Collapse
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
| |
Collapse
|
22
|
Gong F, Wang X, Sun Q, Su X, Hu X, Liu B. Long non-coding RNA LINC00525 interacts with miR-31-5p and miR-125a-5p to act as an oncogenic molecule in spinal chordoma. Biochem Biophys Res Commun 2021; 536:80-87. [PMID: 33370717 DOI: 10.1016/j.bbrc.2020.12.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023]
Abstract
LINC00525 is a new-researched long non-coding RNA (lncRNA) in a few cancers. This study aims at researching the function of LINC00525 in spinal chordoma and the underlying mechanism of action. LINC00525, microRNA-31-5p (miR-31-5p) and microRNA-125a-5p (miR-125a-5p) detection was performed by quantitative real-time polymerase chain reaction (qRT-PCR). We found the high expression of LINC00525 but the low levels of miR-31-5p and miR-125a-5p in spinal chordoma tissues. After LINC00525 was downregulated in spinal chordoma cells, there were inhibitory effects on cell proliferation, migration, invasion and EMT but a promoting effect on cell apoptosis. MiR-31-5p and miR-125a-5p were the downstream targets of LINC00525. The function of LINC00525 knockdown in spinal chordoma cells were achieved by upregulating miR-31-5p and miR-125a-5p. Tumorigenesis of spinal chordoma in vivo was also inhibited by knockdown of LINC00525 via the promotion of miR-31-5p and miR-125a-5p. All these results suggested that LINC00525 targeted miR-31-5p and miR-125a-5p to promote the tumorigenesis and progression of spinal chordoma. LINC00525 can be a novel molecular target in spinal chordoma.
Collapse
Affiliation(s)
- Futai Gong
- Department of Spine Area of Orthopedics, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, 710021, Shaanxi, China
| | - Xiangyang Wang
- Department of Spine Area of Orthopedics, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, 710021, Shaanxi, China
| | - Qing Sun
- Department of Spine Area of Orthopedics, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, 710021, Shaanxi, China
| | - Xiaoqiang Su
- Department of Spine Area of Orthopedics, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, 710021, Shaanxi, China
| | - Xinglv Hu
- Department of Spine Area of Orthopedics, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, 710021, Shaanxi, China
| | - Bo Liu
- Department of Spine Area of Orthopedics, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, 710021, Shaanxi, China.
| |
Collapse
|
23
|
Liu C, Jia Q, Wei H, Yang X, Liu T, Zhao J, Ling Y, Wang C, Yu H, Li Z, Jiao J, Wu Z, Yang C, Xiao J. Apatinib in patients with advanced chordoma: a single-arm, single-centre, phase 2 study. Lancet Oncol 2020; 21:1244-1252. [PMID: 32888455 DOI: 10.1016/s1470-2045(20)30466-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND No standard treatment exists for advanced chordoma. Apatinib has been found to have promising efficacy and manageable adverse effects for the treatment of solid tumours. We aimed to investigate the safety and antitumour activity of apatinib in patients with advanced chordoma. METHODS We did a single-arm, phase 2 study at one tertiary hospital in Shanghai, China. Eligible patients were aged 18-75 years, with histologically confirmed advanced chordoma that was unresectable or resectable only through demolitive surgery, who had previously received surgical treatment, with at least one measurable lesion according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, evidence of tumour progression on enhanced CT or MRI in the previous 6 months, and an Eastern Cooperative Oncology Group performance status of 0-2. Patients received oral 500 mg apatinib once daily until disease progression or unacceptable toxicity. The co-primary endpoints were progression-free survival and objective response rate according to RECIST 1.1 and Choi criteria by investigator assessment. Progression-free survival was assessed in the intention-to-treat population. Objective response rate was assessed in the per-protocol population, which included all enrolled patients who were compliant with the protocol and had at least one post-baseline assessment. Safety was analysed in all patients with complete safety data. This study is ongoing, but recruitment is complete. This study is registered with Chictr.org.cn, ChiCTR-OIC-17013586. FINDINGS Between Aug 21, 2017, and May 31, 2019, we screened 32 patients, of whom 30 were enrolled. Median follow-up was 14·2 months (IQR 9·4-19·7). Of the 27 patients included in the per-protocol population, one patient (3·7%; 95% CI 0-11·3) achieved an objective response according to RECIST, and seven patients (25·9%; 8·3-43·6) achieved an objective response according to Choi criteria. Median progression-free survival was 18 months (95% CI 3-34) according to RECIST and 18 months (3-33) according to Choi criteria. The most common treatment-related grade 3 adverse events were hypertension (seven [24%] of 29 patients) and proteinuria (two [7%]). No treatment-related grade 4 adverse events or treatment-related deaths were observed. INTERPRETATION To our knowledge, this is the first trial of apatinib for the treatment of advanced chordoma. Apatinib shows promising activity and manageable toxicity and thus might be an option for the treatment of advanced chordoma. FUNDING None.
Collapse
Affiliation(s)
- Chao Liu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qi Jia
- Department of Orthopedic Oncology, 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
| | - Tielong Liu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yan Ling
- Department of Clinical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenguang Wang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hongyu Yu
- Department of Pathology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhenxi Li
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Jiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhipeng Wu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Cheng Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| |
Collapse
|
24
|
Chanplakorn P, Lertudomphonwanit T, Homcharoen W, Suwanpramote P, Laohacharoensombat W. Results following surgical resection of recurrent chordoma of the spine: experience in a single institution. World J Surg Oncol 2020; 18:228. [PMID: 32854731 PMCID: PMC7453713 DOI: 10.1186/s12957-020-02005-4] [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: 06/16/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Chordoma of the spine is a low-grade malignant tumor with vague and indolent symptoms; thus, large tumor mass is encountered at the time of diagnosis in almost cases and makes it difficult for en-bloc free-margin resection. Salvage therapy for recurrent chordoma is very challenging due to its relentless nature and refractory to adjuvant therapies. The aim of this present study was to report the oncologic outcome following surgical resection of chordoma of the spine. Materials and methods Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018 at one tertiary-care center was conducted. Results There were 10 patients; 4 females and 6 males were included in this study. Eight patients had local recurrence. The recurrence was encountered at the muscle, surrounding soft tissue, and remaining bony structure. Distant metastases were found in 2 patients. The median time to recurrence or metastasis was 30 months after first surgery. Conclusion En-bloc free-margin resection is mandatory to prevent recurrence. The clinical vigilance and investigation to identify tumor recurrent should be performed every 3 to 6 months, especially in the first 30 months and annually thereafter. Detection of recurrent in early stage with a small mass may be the best chance to perform an en-bloc margin-free resection to prevent further recurrence.
Collapse
Affiliation(s)
- Pongsthorn Chanplakorn
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Thamrong Lertudomphonwanit
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Wittawat Homcharoen
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.,Department of Orthopedics, Prapokklao Hospital, 38 Leab Noen Rd, Tambon Wat Mai, Mueang Chanthaburi District, Chanthaburi, 22000, Thailand
| | - Prakrit Suwanpramote
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Wichien Laohacharoensombat
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| |
Collapse
|
25
|
Benson JC, Vizcaino MA, Kim DK, Carr C, Rose P, Eckel L, Diehn F. Exophytic Lumbar Vertebral Body Mass in an Adult with Back Pain. AJNR Am J Neuroradiol 2020; 41:1786-1790. [PMID: 32819895 DOI: 10.3174/ajnr.a6749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
Chordomas are rare primary bone malignancies derived from notochord remnants. The tumors often are slow-growing and often present with indolent, nonspecific symptoms. Nevertheless, chordomas are locally aggressive and highly prone to local recurrence, necessitating precise planning before biopsy and/or surgical resection. Familiarity with the imaging features of chordomas is, therefore, essential. This case highlights the typical imaging and pathologic features of a spinal chordoma as well as the surgical approach and the patient's subsequent outcome.
Collapse
Affiliation(s)
- J C Benson
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | | | - D K Kim
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - C Carr
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - P Rose
- Orthopedic Surgery (P.R.), Mayo Clinic, Rochester, Minnesota
| | - L Eckel
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - F Diehn
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| |
Collapse
|
26
|
Comparison of Wide Margin and Inadequate Margin for Recurrence in Sacral Chordoma: A Meta-Analysis. Spine (Phila Pa 1976) 2020; 45:814-819. [PMID: 31977678 DOI: 10.1097/brs.0000000000003386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN .: A meta-analysis. OBJECTIVE .: The goal of this study was to accurately evaluate the risk ratio (RR) of recurrence in chordoma patients with wide margin after removing the tumors using surgery, compared with inadequate margin (intralesional or marginal). SUMMARY OF BACKGROUND DATA .: As a rare malignant bone cancer, the more effective treatment for sacral chordoma is still surgical resection. However, there is no convincing evidence and risk ratio about sacral chordoma patients would be benefit from which kind of surgical margin. METHODS .: We searched the PubMed, Cochrane Library, Web of Science, and EMBASE from inception to December 2018. The heterogeneity analysis and calculation of the pooled risk ratio were performed using RevMan 5.3 software. The assessment of publication bias and sensitivity analysis was conducted using StataSE 15.1 software. The protocol for this meta-analysis was registered on International prospective register of systematic reviews (PROSPERO, CRD42019127441). RESULTS .: Twelve studies with a total of 436 patients who met the inclusion criteria were included. The pooled results indicated that patients in the wide group had lower recurrence rate than those in the inadequate group (RR = 0.42, 95% confidence interval [CI] 0.31-0.57; P < 0.001). And patients in the wide group had lower mortality rate than those in the inadequate group (RR = 0.49, 95% CI 0.26-0.91; P = 0.02). No significant differences in the risk of mortality were found between relapsed patients in the two groups (RR = 0.64, 95% CI 0.35-1.15; P = 0.13). CONCLUSION .: In sacral chordoma patients, wide margin is associated with low recurrence risk, when it is feasible, a wide excision should be considered appropriate for sacrum chordoma. LEVEL OF EVIDENCE 2.
Collapse
|
27
|
Murray FR, Snider JW, Schneider RA, Walser M, Bolsi A, Pica A, Lomax AJ, Weber DC. Prognostic factors for spinal chordomas and chondrosarcomas treated with postoperative pencil-beam scanning proton therapy: a large, single-institution experience. J Neurosurg Spine 2020; 32:921-930. [PMID: 32005008 DOI: 10.3171/2019.11.spine1927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/15/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this paper was to evaluate the prognostic factors in surgical and adjuvant care for spinal chordomas and chondrosarcomas after surgery followed by high-dose pencil-beam scanning proton therapy (PBS-PT). METHODS From 1997 to 2016, 155 patients (61 female patients; median age 55 years) with spinal (cervical, n = 61; thoracic, n = 29; lumbar, n = 13; sacral, n = 46; pelvic, n = 6) classic chordomas (n = 116) and chondrosarcomas (n = 39; most were low grade) were treated with maximal safe resection followed by PBS-PT (median dose prescribed: 74 Gy [relative biological effectiveness], range 48.6-77 Gy). The majority of patients (n = 153, 98.7%) had undergone at least 1 resection prior to PBS-PT (median 1, range 0-5; biopsy only, n = 2). Fewer than half (45.1%) of the surgeries were rated as gross-total resections (GTRs) prior to PBS-PT. Surgical stabilization (SS) was present in 39% of all patients (n = 60). Ninety-one patients (59%) presented with macroscopic tumor at the start of PBS-PT. The median follow-up duration was 64.7 months (range 12.2-204.8 months). RESULTS The 5-year local tumor control, disease-free survival (DFS), and overall survival were 64.9% (95% CI 56.3%-73.5%), 59.4% (95% CI 50.6%-68.2%), and 77.9% (95% CI 70.6%-85.2%), respectively. In total, 63 patients (40.6%) experienced failure during the follow-up period: local only in 32 (20.6%), distal only in 7 (4.5%), local + distal in 19 (12.3%), surgical pathway failure (SPF) only in 2 (1.3%), local + SPF in 2 (1.3%), and distal + SPF in 1 (< 1%). Univariate analysis identified gross residual disease, the presence of SS, and treatment era prior to 2008 as highly significant for worse outcome, with all 3 remaining significant on multivariate analysis. The type of surgery (GTR or subtotal resection/biopsy) and whether GTR was achieved by en bloc or curettage did not show a significant prognostic effect. Surgical complications prior to PBS-PT were present in 42.5% of all surgically treated patients and were seen more commonly in patients with multiple surgical interventions (p = 0.005) and those operated on with the intent of en bloc resection (p = 0.006). CONCLUSIONS The extent of resection and metallic stabilization substantially influenced clinical outcomes for patients with spinal chordoma or chondrosarcoma despite high-dose adjuvant PBS-PT. Optimal upfront surgical management of these tumors continues to include GTR, as possible, with prompt adjuvant proton therapy.
Collapse
Affiliation(s)
- Fritz R Murray
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
| | - James W Snider
- 2Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Marc Walser
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
| | | | - Alessia Pica
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
| | - Antony J Lomax
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
- 3Department of Physics, ETH, Zurich
| | - Damien C Weber
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
- 4Radiation Oncology Department, University Hospital of Bern
- 5Radiation Oncology Department, University Hospital of Zurich, Switzerland; and
| |
Collapse
|
28
|
The sacral chordoma margin. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1415-1422. [PMID: 32402509 DOI: 10.1016/j.ejso.2020.04.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Aim of the manuscript is to discuss how to improve margins in sacral chordoma. BACKGROUND Chordoma is a rare neoplasm, arising in half cases from the sacrum, with reported local failure in >50% after surgery. METHODS A multidisciplinary meeting of the "Chordoma Global Consensus Group" was held in Milan in 2017, focusing on challenges in defining and achieving optimal margins in chordoma with respect to surgery, definitive particle radiation therapy (RT) and medical therapies. This review aims to report on the outcome of the consensus meeting and to provide a summary of the most recent evidence in this field. Possible new ways forward, including on-going international clinical studies, are discussed. RESULTS En-bloc tumor-sacrum resection is the cornerstone of treatment of primary sacral chordoma, aiming to achieve negative microscopic margins. Radical definitive particle therapy seems to offer a similar outcome compared to surgery, although confirmation in comparative trials is lacking; besides there is still a certain degree of technical variability across institutions, corresponding to different fields of treatment and different tumor coverage. To address some of these questions, a prospective, randomized international study comparing surgery versus definitive high-dose RT is ongoing. Available data do not support the routine use of any medical therapy as (neo)adjuvant/cytoreductive treatment. CONCLUSION Given the significant influence of margins status on local control in patients with primary localized sacral chordoma, the clear definition of adequate margins and a standard local approach across institutions for both surgery and particle RT is vital for improving the management of these patients.
Collapse
|
29
|
Westbroek EM, Pennington Z, Ehresman J, Ahmed AK, Gailloud P, Sciubba DM. Vertebral Artery Sacrifice versus Skeletonization in the Setting of Cervical Spine Tumor Resection: Case Series. World Neurosurg 2020; 139:e601-e607. [PMID: 32330623 DOI: 10.1016/j.wneu.2020.04.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tumors of the cervical spine often encase 1 or both vertebral arteries (VA), presenting the treating surgeon with the dilemma of whether to sacrifice or skeletonize the artery. We propose an algorithm for VA management in surgeries for cervical neoplasms METHODS: A retrospective review was carried out of 67 patients undergoing resection of cervical spine tumors with VA involvement. Patients were categorized by tumor origin (primary vs. metastatic) and degree of circumferential VA involvement: 1) abutment only; 2) <180° circumferential involvement; 3) >180° circumferential involvement without complete encasement; or 4) complete encasement. RESULTS Twelve patients (18%) underwent VA sacrifice, whereas 55 (82%) underwent VA skeletonization. Compared with 11/30 patients with primary tumors (37%), only 1/37 patients (3%) with metastatic disease underwent VA sacrifice (P < 0.01). This patient had invasion of the V2 arterial wall, requiring VA sacrifice. Odds of VA sacrifice also increased with increasing circumferential involvement (P < 0.01). No patients with simple abutment or 0°-180° circumferential involvement underwent sacrifice, whereas 6 of 10 (60%) with 180°-359° involvement and 6 of 29 (21%) with complete encasement underwent VA sacrifice. Of the 27 patients with ≥180° involvement, the reasons for preserving the VA were metastatic disease at the time of treatment (n = 18), a compromised contralateral VA (n = 7), vertebrobasilar junction aplasia (n = 1), and presence of a radiculomedullary artery at the affected level (n = 1). CONCLUSIONS Primary tumor disease and >180° of circumferential VA involvement should be considered as indications for intraoperative sacrifice of the VA pending preoperative angiographic evaluation for contraindications.
Collapse
Affiliation(s)
- Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
30
|
Zou MX, Zheng BW, Liu FS, Wang XB, Hu JR, Huang W, Dai ZH, Zhang QS, Liu FB, Zhong H, Jiang Y, She XL, Li XB, Lv GH, Li J. The Relationship Between Tumor-Stroma Ratio, the Immune Microenvironment, and Survival in Patients With Spinal Chordoma. Neurosurgery 2020; 85:E1095-E1110. [PMID: 31501892 DOI: 10.1093/neuros/nyz333] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/23/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Currently, little is known about the clinical relevance of tumor-stroma ratio (TSR) in chordoma and data discussing the relationship between TSR and immune status of chordoma are lacking. OBJECTIVE To characterize TSR distribution in spinal chordoma, and investigated its correlation with clinicopathologic or immunological features of patients and outcome. METHODS TSR was assessed visually on hematoxylin and eosin-stained sections from 54 tumor specimens by 2 independent pathologists. Multiplex immunofluorescence was used to quantify the expression levels of microvessel density, Ki-67, Brachyury, and tumor as well as stromal PD-L1. Tumor immunity status including the Immunoscore and densities of tumor-infiltrating lymphocytes (TILs) subtypes were obtained from our published data and reanalyzed. RESULTS Bland-Altman plot showed no difference between mean TSR derived from the two observers. TSR was positively associated with stromal PD-L1 expression, the Immunoscore and CD3+ as well as CD4+ TILs density, but negatively correlated with tumor microvessel density, Ki-67 index, surrounding muscle invasion by tumor and number of Foxp3+ and PD-1+ TILs. Low TSR independently predicted poor local recurrence-free survival and overall survival. Moreover, patients with low TSR and low Immunoscore chordoma phenotype were associated with the worst survival. More importantly, combined TSR and Immunoscore accurately reflected prognosis and enhanced the ability of TSR or Immunoscore alone for outcome prediction. CONCLUSION These data reveal the significant impact of TSR on tumor progression and immunological response of patients. Subsequent use of agents targeting the stroma compartment may be an effective strategy to treat chordoma especially in combination with immune-based drugs.
Collapse
Affiliation(s)
- Ming-Xiang Zou
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Bo-Wen Zheng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Fu-Sheng Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Jia-Rui Hu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Wei Huang
- Institute of Precision Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Zhe-Hao Dai
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Qian-Shi Zhang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Fu-Bing Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Hua Zhong
- Department of Orthopedics Surgery, Central Hospital of Yi Yang, Yiyang, China
| | - Yi Jiang
- Department of Pathology, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Xiao-Ling She
- Department of Pathology, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Xiao-Bing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| |
Collapse
|
31
|
Beer J, Kountouri M, Kole AJ, Murray FR, Leiser D, Kliebsch U, Combescure C, Pica A, Bachtiary B, Bolsi A, Lomax AJ, Walser M, Weber DC. Outcomes, Prognostic Factors and Salvage Treatment for Recurrent Chordoma After Pencil Beam Scanning Proton Therapy at the Paul Scherrer Institute. Clin Oncol (R Coll Radiol) 2020; 32:537-544. [PMID: 32222414 DOI: 10.1016/j.clon.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
AIMS The outcome of chordoma patients with local or distant failure after proton therapy is not well established. We assessed the disease-specific (DSS) and overall survival of patients recurring after proton therapy and evaluated the prognostic factors affecting DSS. MATERIALS AND METHODS A retrospective analysis was carried out of 71 recurring skull base (n = 36) and extracranial (n = 35) chordoma patients who received adjuvant proton therapy at initial presentation (n = 42; 59%) or after post-surgical recurrence (n = 29; 41%). The median proton therapy dose delivered was 74 GyRBE (range 62-76). The mean age was 55 ± 14.2 years and the male/female ratio was about one. RESULTS The median time to first failure after proton therapy was 30.8 months (range 3-152). Most patients (n = 59; 83%) presented with locoregional failure only. There were only 12 (17%) distant failures, either with (n = 5) or without (n = 7) synchronous local failure. Eight patients (11%) received no salvage therapy for their treatment failure after proton therapy. Salvage treatments after proton therapy failure included surgery, systemic therapy and additional radiotherapy in 45 (63%), 20 (28%) and eight (11%) patients, respectively. Fifty-three patients (75%) died, most often from disease progression (47 of 53 patients; 89%). The median DSS and overall survival after failure was 3.9 (95% confidence interval 3.1-5.1) and 3.4 (95% confidence interval 2.5-4.4) years, respectively. On multivariate analysis, extracranial location and late failure (≥31 months after proton therapy) were independent favourable prognostic factors for DSS. CONCLUSION The survival of chordoma patients after a treatment failure following proton therapy is poor, particularly for patients who relapse early or recur in the skull base. Although salvage treatment is administered to most patients with uncontrolled disease, they will ultimately die as a result of disease progression in most cases.
Collapse
Affiliation(s)
- J Beer
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - M Kountouri
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Department of Radiation Oncology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - A J Kole
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - F R Murray
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - D Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - U Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - C Combescure
- Unit for Clinical Epidemiology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - A Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - B Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - A Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - A J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - M Walser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - D C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Department of Radiation Oncology, University Hospital of Zürich, Zürich, Switzerland; Department of Radiation Oncology, University Hospital of Bern, Bern, Switzerland.
| |
Collapse
|
32
|
Revision surgery for tumors of the thoracic and lumbar spine: causes, prevention, and treatment strategy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:66-77. [PMID: 31960144 DOI: 10.1007/s00586-019-06276-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 10/29/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Revision surgery in spine tumor surgery can offer peculiar challenges given the severity of the majority of these lesions and the complexity of surgical procedures that are required. MATERIALS AND METHODS AND RESULTS Based on literature review and on personal experience, surgical site infection, cerebrospinal fluid leakage, tumor recurrence and hardware failures are some of the possible causes of surgical revision in this set of patients. CONCLUSIONS The aim of this study is to evaluate the most frequent complications that can lead to revision in spine tumor patients, to provide suggestions on how to prevent these events and to offer reasonable strategies to properly plan and perform a revision surgery. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
33
|
Massaad E, Fatima N, Hadzipasic M, Alvarez-Breckenridge C, Shankar GM, Shin JH. Predictive Analytics in Spine Oncology Research: First Steps, Limitations, and Future Directions. Neurospine 2019; 16:669-677. [PMID: 31905455 PMCID: PMC6944986 DOI: 10.14245/ns.1938402.201] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 01/29/2023] Open
Abstract
The potential of big data analytics to improve the quality of care for patients with spine tumors is significant. At this moment, the application of big data analytics to oncology and spine surgery is at a nascent stage. As such, efforts are underway to advance data-driven oncologic care, improve patient outcomes, and guide clinical decision making. This is both relevant and critical in the practice of spine oncology as clinical decision making is often made in isolation looking at select variables deemed relevant by the physician. With rapidly evolving therapeutics in surgery, radiation, interventional radiology, and oncology, there is a need to better develop decision-making algorithms utilizing the vast data available for each patient. The challenges and limitations inherent to big data analyses are presented with an eye towards future directions.
Collapse
Affiliation(s)
- Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nida Fatima
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Muhamed Hadzipasic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ganesh M. Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
34
|
Bettegowda C, Yip S, Jiang B, Wang WL, Clarke MJ, Lazary A, Gambarotti M, Zhang M, Sciubba DM, Wolinsky JP, Goodwin CR, McCarthy E, Germscheid NM, Sahgal A, Gokaslan ZL, Boriani S, Varga PP, Fisher CG, Rhines LD. Prognostic significance of human telomerase reverse transcriptase promoter region mutations C228T and C250T for overall survival in spinal chordomas. Neuro Oncol 2019; 21:1005-1015. [PMID: 30976795 PMCID: PMC6682209 DOI: 10.1093/neuonc/noz066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spinal chordomas, a subtype of primary spinal column malignancies (PSCM), are rare tumors with poor prognosis, and we have limited understanding of the molecular drivers of neoplasia. METHODS Study design was a retrospective review of prospectively collected data with cross-sectional survival. Archived paraffin embedded pathologic specimens were collected for 133 patients from 6 centers within Europe and North America between 1987 and 2012. Tumor DNA was extracted and the human telomerase reverse transcriptase (hTERT) promoter was sequenced. The hTERT mutational status was correlated with overall survival (OS) and time to first local recurrence. RESULTS Ninety-two chordomas, 26 chondrosarcomas, 7 osteosarcomas, 3 Ewing's sarcomas, and 5 other malignant spinal tumors were analyzed. Median OS following surgery was 5.8 years (95% CI: 4.6 to 6.9) and median time to first local recurrence was 3.9 years (95% CI: 2.5 to 6.7). Eight chordomas, 2 chondrosarcomas, 1 Ewing's sarcoma, and 1 other malignant spinal tumor harbored either a C228T or C250T mutation in the hTERT promoter. In the overall cohort, all patients with hTERT mutation were alive at 10 years postoperative with a median OS of 5.1 years (95% CI: 4.5 to 6.6) (P = 0.03). hTERT promoter mutation was observed in 8.7% of spinal chordomas, and 100% of chordoma patients harboring the mutation were alive at 10 years postoperative compared with 67% patients without the mutation (P = 0.05). CONCLUSIONS We report for the first time that hTERT promoter mutations C228T and C250T are present in approximately 8.7% of spinal chordomas. The presence of hTERT mutations conferred a survival benefit and could potentially be a valuable positive prognostic molecular marker in spinal chordomas.
Collapse
Affiliation(s)
- Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Marco Gambarotti
- Department of Pathology, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Ming Zhang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Edward McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Peter Pal Varga
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Charles G Fisher
- Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Laurence D Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
35
|
Nomogram for Individualized Prediction and Prognostic Factors for Survival in Patients with Primary Spinal Chordoma: A Population-Based Longitudinal Cohort Study. World Neurosurg 2019; 128:e603-e614. [DOI: 10.1016/j.wneu.2019.04.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
|
36
|
Sayyid SK, Wong PK, Read W, Monson DK, Umpierrez M, Gonzalez F, Kakarala A, Singer AD. The clincoradiologic spectrum of notochordal derived masses. Clin Imaging 2019; 56:124-134. [PMID: 31029011 DOI: 10.1016/j.clinimag.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Abstract
The notochord is an essential part of human development that regresses with age. Masses derived from notochordal tissue may be encountered during imaging of the neuroaxis. Fortunately, the majority of these are benign and can usually be differentiated by radiological and clinical findings. In this manuscript, we discuss the clinical and radiologic presentation of the four notochordal derived masses and present a brief overview of their management.
Collapse
Affiliation(s)
- Samia K Sayyid
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Philip K Wong
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - William Read
- Department of Hematology and Oncology, Emory University Hospital, Atlanta, GA, USA
| | - David K Monson
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Aparna Kakarala
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA.
| |
Collapse
|
37
|
Kerekes D, Goodwin CR, Ahmed AK, Verlaan JJ, Bettegowda C, Abu-Bonsrah N, Sciubba DM. Local and Distant Recurrence in Resected Sacral Chordomas: A Systematic Review and Pooled Cohort Analysis. Global Spine J 2019; 9:191-201. [PMID: 30984500 PMCID: PMC6448196 DOI: 10.1177/2192568217741114] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Sacral chordomas are rare, primary tumors of the spine, best treated with en bloc resection. The purpose of this study was to assess the literature for resected sacral chordoma and to quantify the prevalence of, risk factors for, and treatment outcomes of local and distant recurrence therein. METHODS We searched 5 online databases from January 1980 to May 2016 to find articles that report survival, recurrence outcomes, and/or prognostic factors for the resected sacral chordoma patient population. Characteristics and clinical outcomes of the pooled cohort are reported. Fisher exact tests, unpaired t tests, and one-way analysis of variance were used to investigate patient- and treatment-associated prognostic factors for local and distant recurrence. Survival analyses were performed for time to local recurrence and death. The protocol's PROSPERO ID is CRD42015024384. RESULTS Fifty-seven studies, with 1235 unique sacral chordoma patients, were included in this review. Local and distant recurrence occurred in 42.6% and 22.4% of patients with adequate follow-up, respectively. Kaplan-Meier overall median survival for patients with and without recurrence were 98 and 209 months after surgery, respectively. Wide surgical margin was associated with a lower rate of local recurrence; and wide surgical margin, female sex, and patient age ≥65 years were associated with lower rates of distant recurrence. CONCLUSIONS While surgical margin remains the most significant prognostic factor for local and distant recurrence, combined surgical approach may be associated with local recurrence. Male sex and age <65 years may be associated with distant recurrence. Patients with risk factors for recurrence should undergo close monitoring to maximize survival.
Collapse
Affiliation(s)
- Daniel Kerekes
- The Johns Hopkins University, Baltimore, MD, USA,These authors contributed equally to this work
| | - C. Rory Goodwin
- Duke University Medical Center, Durham, NC, USA,These authors contributed equally to this work.,C. Rory Goodwin, Department of Neurosurgery, Duke
University Medical Center, 200 Trent Drive, Durham, NC 27710, USA.
| | - A. Karim Ahmed
- The Johns Hopkins University, Baltimore, MD, USA,These authors contributed equally to this work
| | | | | | | | | |
Collapse
|
38
|
Prognostic significance of pretreatment plasma D-dimer levels in patients with spinal chordoma: a retrospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1480-1490. [PMID: 30684054 DOI: 10.1007/s00586-018-05872-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/22/2018] [Accepted: 12/22/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Plasma D-dimer levels, a marker of hypercoagulation, have not only been used as an indicator for cascaded reaction in the coagulation process but are also reported to be an underlying biomarker in several types of cancers. This retrospective cohort study was designed to evaluate the prognostic value of preoperative plasma D-dimer level in patients with spinal chordoma. METHODS We enrolled 224 patients who underwent surgery for spinal chordoma between 2002 and 2015 at Changzheng Orthopedic Oncology Center. Preoperative clinical parameters were recorded and evaluated by univariate and multivariate Cox regression models. The correlation between preoperative plasma D-dimer levels and survival was assessed using the Kaplan-Meier method. RESULTS The optimal cutoff value of pretreatment D-dimer was 840 μg/L determined by X-tile. DFS (disease-free survival) was 64.7% and OS (overall survival) was 75% in the cohort. Multivariate Cox regression model identified D-dimer level as an independent prognostic factor of DFS and OS, as well as treatment history, preoperative Karnofsky Performance Scale, preoperative Frankel score, pathology classification and adjuvant radiotherapy (p < 0.05). In addition, D-dimer level may also be an effective supplement for defining tumor Enneking staging (p < 0.05). CONCLUSIONS Higher pretreatment plasma D-dimer level was associated with a poor prognosis in chordoma and could be used as an independent prognostic factor for the survival of the patients with spinal chordoma. With supplementation of D-dimer level, Enneking stage may be more able to accurate stratify individualized risk and determine clinical management. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
39
|
Sacral chordoma: clinical experience of a series of 11 patients over 18 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:9-15. [PMID: 30066091 DOI: 10.1007/s00590-018-2284-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/21/2018] [Indexed: 12/25/2022]
Abstract
Sacral chordoma are rare low-to-intermediate grade malignant tumours that occur most commonly within the sacrum. Sacrectomy with wide resection margins seems to offer the best long-term prognosis. This study aims to review the management of sacral chordomas including the duration of symptoms, features, treatment, complications and local recurrence rate following surgery at a tertiary centre. We retrospectively reviewed 11 patients treated at our institution between years 1999 and 2015. Patient data included age, sex, history, radiographs, surgical details, onset of recurrence, subsequent treatment, disease-free survival and overall survival were analyzed. Nine patients underwent surgical management with 1 through a sacral approach and eight patients through a combined abdominosacral approach. Despite wide resection in our series, sacral chordoma poses a major problem with approximately 60% of patients having local recurrence in their follow-up.
Collapse
|
40
|
Sasaki T, Moritani T, Belay A, Capizzano AA, Sato SP, Sato Y, Kirby P, Ishitoya S, Oya A, Toda M, Takahashi K. Role of the Apparent Diffusion Coefficient as a Predictor of Tumor Progression in Patients with Chordoma. AJNR Am J Neuroradiol 2018; 39:1316-1321. [PMID: 29724767 DOI: 10.3174/ajnr.a5664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging may aid in distinguishing aggressive chordoma from nonaggressive chordoma. This study explores the prognostic role of the apparent diffusion coefficient in chordomas. MATERIALS AND METHODS Sixteen patients with residual or recurrent chordoma were divided postoperatively into those with an aggressive tumor, defined as a growing tumor having a doubling time of <1 year, and those with a nonaggressive tumor on follow-up MR images. The ability of the ADC to predict an aggressive tumor phenotype was investigated by receiver operating characteristic analysis. The prognostic role of ADC was assessed using a Kaplan-Meier curve with a log-rank test. RESULTS Seven patients died during a median follow-up of 48 months (range, 4-126 months). Five of these 7 patients were in the aggressive tumor group, and 2 were in the nonaggressive tumor group. The mean ADC was significantly lower in the aggressive tumor group than in the nonaggressive tumor group (P = .002). Receiver operating characteristic analysis showed that a cutoff ADC value of 1.494 × 10-3 × mm2/s could be used to diagnose aggressive tumors with an area under the curve of 0.983 (95% CI, 0.911-1.000), a sensitivity of 1.000 (95% CI, 0.541-1.000), and a specificity of 0.900 (95% CI, 0.555-0.998). Furthermore, a cutoff ADC of ≤1.494 × 10-3 × mm2/s was associated with a significantly worse prognosis (P = .006). CONCLUSIONS Lower ADC values could predict tumor progression in postoperative chordomas.
Collapse
Affiliation(s)
- T Sasaki
- From the Departments of Radiology (T.S., T.M., A.B., A.A.C., S.P.S., Y.S.)
- Asahikawa Medical University (T.S., S.I., A.O., M.T., K.T.), Asahikawa, Hokkaido, Japan
| | - T Moritani
- From the Departments of Radiology (T.S., T.M., A.B., A.A.C., S.P.S., Y.S.)
- Department of Radiology (T.M.), University of Michigan, Ann Arbor, Michigan
| | - A Belay
- From the Departments of Radiology (T.S., T.M., A.B., A.A.C., S.P.S., Y.S.)
| | - A A Capizzano
- From the Departments of Radiology (T.S., T.M., A.B., A.A.C., S.P.S., Y.S.)
| | - S P Sato
- From the Departments of Radiology (T.S., T.M., A.B., A.A.C., S.P.S., Y.S.)
| | - Y Sato
- From the Departments of Radiology (T.S., T.M., A.B., A.A.C., S.P.S., Y.S.)
| | - P Kirby
- Pathology (P.K.), University of Iowa, Iowa City, Iowa
| | - S Ishitoya
- Asahikawa Medical University (T.S., S.I., A.O., M.T., K.T.), Asahikawa, Hokkaido, Japan
| | - A Oya
- Asahikawa Medical University (T.S., S.I., A.O., M.T., K.T.), Asahikawa, Hokkaido, Japan
| | - M Toda
- Asahikawa Medical University (T.S., S.I., A.O., M.T., K.T.), Asahikawa, Hokkaido, Japan
| | - K Takahashi
- Asahikawa Medical University (T.S., S.I., A.O., M.T., K.T.), Asahikawa, Hokkaido, Japan
| |
Collapse
|
41
|
Francis GJ, Ngo-Huang A, Rhines LD, Bruera E. The challenges of providing rehabilitation for patients undergoing sacrectomy: two case reports. Eur J Phys Rehabil Med 2018; 55:526-529. [PMID: 29898586 DOI: 10.23736/s1973-9087.18.05112-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sacral neoplasms often present as large masses that often require sacrectomy. Multiple sacral nerve roots may be compromised post-sacrectomy and postoperative complications may result in impaired mobility, pain, orthostasis, and neurogenic bowel and bladder. CASE SERIES Case 1, 58 year-old female with a sacral solitary fibrous tumor underwent a high-level sacrectomy and bilateral gluteal muscle flaps. Her rehabilitation course included management of pain, orthostasis, and neurogenic bowel and bladder. Case 2, 67 year-old male with sacral chordoma underwent high-level sacrectomy and bilateral gluteal muscle flaps. His rehabilitation course was complicated by refractory orthostatic hypotension, pain, and wound impairment, which resulted in slow rehabilitation progression and bowel and bladder training. Progression of activity in both cases was limited by surgical restrictions to support wound healing. CLINICAL REHABILITATION IMPACT Multidisciplinary efforts after a sacrectomy are vital to successful rehabilitation. Highly functional outcomes are seen, including independent bowel and bladder management and return to preoperative ambulatory status.
Collapse
Affiliation(s)
- George J Francis
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA -
| | - Laurence D Rhines
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
42
|
Dalle Ore CL, Lau D, Davis JL, Safaee MM, Ames CP. Rare case of a recurrent juvenile ossifying fibroma of the lumbosacral spine. J Neurosurg Spine 2018. [DOI: 10.3171/2017.10.spine17947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Juvenile ossifying fibroma (JOF) is a rare benign bone tumor that occurs most frequently in the craniofacial bones of children and young adults. There are few case reports that describe its involvement outside the craniofacial skeleton, especially within the spinal column. While JOF is classified as a benign lesion, it may be locally aggressive and demonstrate a high propensity for recurrence, even after resection. Definitive surgical management may be challenging in naive cases, but it is particularly challenging in recurrent cases and when extensive spinal reconstruction is warranted. In this report, the authors describe the diagnosis and surgical management of a 29-year-old man who presented with a large recurrent sacral trabecular-subtype JOF. A review of literature regarding JOFs, management of recurrent primary spinal tumors, and sacral reconstruction are discussed.
Collapse
Affiliation(s)
| | - Darryl Lau
- Departments of 1Neurological Surgery and
| | | | | | | |
Collapse
|
43
|
Zuckerman SL, Bilsky MH, Laufer I. Chordomas of the Skull Base, Mobile Spine, and Sacrum: An Epidemiologic Investigation of Presentation, Treatment, and Survival. World Neurosurg 2018; 113:e618-e627. [DOI: 10.1016/j.wneu.2018.02.109] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 01/14/2023]
|
44
|
Jullien-Petrelli AC, García-Sabrido JL, Orue-Echebarria MI, Lozano P, Álvarez A, Serrano J, Calvo FM, Calvo-Haro JA, Lasso JM, Asencio JM. Role of intraoperative radiotherapy in the treatment of sacral chordoma. Spine J 2018; 18:632-638. [PMID: 28882523 DOI: 10.1016/j.spinee.2017.08.255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/29/2017] [Accepted: 08/29/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. To date, there are no series available in literature combining surgery and intraoperative radiotherapy (IORT). PURPOSE The objective of this study was to report the experience of our center in the management of sacral chordoma combining radical resection with both external radiotherapy and IORT. STUDY DESIGN This is a retrospective case series. PATIENT SAMPLE The patient sample included 15 patients with sacral chordoma resected in our center from 1998 to 2015. OUTCOME MEASURES The outcome measures were overall survival (OS), disease-free survival (DFS), and rates of local and distant recurrences. METHODS We retrospectively reviewed the records of all the patients with sacral chordoma resected in our center from 1998 to December 2015. Overall survival, DFS, and rates of local and distant recurrences were calculated. Results between patients treated with or without IORT were compared. RESULTS A total of 15 patients were identified: 8 men and 7 women. The median age was 59 years (range 28-77). Intraoperative radiotherapy was applied in nine patients and six were treated with surgical resection without IORT. In 13 patients, we performed the treatment of the primary tumor, and in two patients, we performed the treatment of recurrence disease. A posterior approach was used in four patients. Wide surgical margins (zero residue) were achieved in six patients, marginal margins (microscopic residue) were achieved in seven patients, and there were no patients with intralesional (R2) margins. At a median follow-up of 38 months (range 11-209 months), the 5-year OS in the IORT group was 100% versus 53% in the group of non-IORT (p=.05). The median DFS in the IORT group was 85 months, and that in the non-IORT group was 41 months. In the group without IORT, two patients died and nobody died during the follow-up in the group treated with IORT. High-sacrectomy treated patients had a median survival of 41 months, and low-sacrectomy treated patients had a median survival of 90 months. Disease-free survival in patients without gluteal involvement was 100% at 5 years, and that in patients with gluteal involvement was 40%. All patients with a recurrence in our study had gluteal involvement. CONCLUSIONS Multidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in OS and DFS. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed to confirm the utility of IORT.
Collapse
Affiliation(s)
- Ariel Christian Jullien-Petrelli
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - J L García-Sabrido
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - M I Orue-Echebarria
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - P Lozano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - A Álvarez
- Servicio de Radioterapia, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - J Serrano
- Servicio de Radioterapia, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - F M Calvo
- Servicio de Radioterapia, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - J A Calvo-Haro
- Servicio de Traumatología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - J M Lasso
- Servicio de Cirugía Plástica, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain
| | - J M Asencio
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid 28007, Spain.
| |
Collapse
|
45
|
The importance of preoperative tissue sampling for mobile spine chordomas: literature review and report of two cases. Spinal Cord Ser Cases 2018; 4:21. [PMID: 29560278 DOI: 10.1038/s41394-018-0061-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/24/2018] [Indexed: 11/08/2022] Open
Abstract
Introduction Pre-operative biopsy and diagnosis of chordomas of the mobile spine is indicated as en bloc resections improve outcomes. This review of the management of mobile spine chordomas includes two cases of unexpected mobile spine chordomas where a preoperative tissue diagnosis was decided against and may have altered surgical decision-making. Case presentation Two lumbar spine chordomas thought to be metastatic and primary bony lesions preoperatively were not biopsied before surgery and eventual pathology revealed chordoma. Preoperative diagnoses were questioned during surgery after an intraoperative tissue diagnosis of chordoma in one case and unclear pathology with non-characteristic tumor morphology in the other. The surgical plan was altered in these cases to maximize resection as en bloc resection reduces the risk of local recurrence in chordoma. Discussion Mobile spine chordomas are rare and en bloc resection is recommended, contrary to the usual approach to more common spine tumors. Since en bloc resection of spine chordomas improves disease free survival, it has been recommended that tissue diagnosis be obtained preoperatively when chordoma is considered in the differential diagnosis, in order to guide surgical planning. We present two cases where a preoperative biopsy was considered but not obtained after neuroradiology consultation and imaging review, which may have been managed differently if the diagnosis of spine chordomas were known pre-operatively.
Collapse
|
46
|
Cryosurgery in the excision of a giant local recurrent sacral chordoma: a case report and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:3059-3063. [DOI: 10.1007/s00586-017-5438-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 11/27/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
|
47
|
Colia V, Stacchiotti S. Medical treatment of advanced chordomas. Eur J Cancer 2017; 83:220-228. [PMID: 28750274 DOI: 10.1016/j.ejca.2017.06.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/23/2017] [Accepted: 06/28/2017] [Indexed: 12/27/2022]
Abstract
Chordoma is a very rare bone sarcoma that can arise from any site along the spine and from the skull base. En bloc resection is the gold standard for treatment while radiation therapy has been shown to provide both curative and palliative benefit. Unfortunately, local recurrences are common, even after a complete surgical resection, and up to 40% of patients suffer from distant metastases, while salvage treatments are challenging. Patients carrying an advanced disease need a systemic treatment. Unluckily, conventional chordoma are insensitive to cytotoxic chemotherapy that is considered the standard treatment option in patients with metastatic sarcoma. In the last decade, innovative therapies have been introduced, positively impacting disease control and patients' quality of life. In addition, a better understanding of the molecular characteristics of chordoma allowed to detect new potential targets. This review is focused on the pharmacological management of patients affected by an advanced disease, starting with a summary of data available on conventional chemotherapy, then moving to a deeper analysis of available data on molecular agents and immunotherapy, and finally providing an update on ongoing clinical trials and future prospective.
Collapse
Affiliation(s)
- Vittoria Colia
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy.
| | - Silvia Stacchiotti
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy.
| |
Collapse
|
48
|
Hdeib A, Wright JM. Brachyury-targeting immunotherapy for chordomas: treatment with GI-6301, a Saccharomyces cerevisiae yeast-based cancer vaccine. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1331126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Alia Hdeib
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - James M. Wright
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
49
|
|