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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.
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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
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Zhong N, Yu D, Yang M, Lu X, Zhang Q, Wei W, Jiao J, Yang X, Zhu Z, Chen S, Xiao J. A retrospective study on the mechanism underlying quick transfer from response to resistance in a repeated recurrent chordoma patient with molecular alterations treated with Palbociclib. J Cancer Res Clin Oncol 2024; 150:95. [PMID: 38369555 PMCID: PMC10874909 DOI: 10.1007/s00432-023-05560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
PURPOSE There is no approved targeted therapy for chordoma at present. Although several preclinical studies have implied the potential applicability of CDK4/6 inhibitor for this rare tumor, no clinical evidence has been documented so far. The purpose of this study was to elucidate the therapeutic efficacy of CDK4/6 inhibitor for chordoma. METHODS The next generation sequencing (as for whole-exome sequencing, WES assay) and immunohistochemical (IHC) staining of the chordoma tissue from a patient with an advanced lesion were performed before treatment. Then, the patient was treated with Palbociclib for 4 months until progression occurred in the 5th month. Surgical resection was implemented and the tumor tissue was obtained postoperatively for assessment of molecular alterations. RESULTS Molecular features of the tumor before medical treatment suggested applicability of CDK4/6 inhibitor and the patient showed partial response (PR) according to Choi Criteria after 4 months treating with Palbociclib until progression occurred. Then, a drastic molecular alteration of the tumor as represented by emergence of dramatic E2F amplification, which is known to induce CDK4/6 independent cell-cycle entry and progression after treatment, was detected. The findings in this patient demonstrated tumor evolution under drug pressure. CONCLUSION The findings of the present study suggest the feasibility of Palbociclib for the clinical treatment of chordoma, and imply the necessity of combination therapies rather single drug administration due to the quick resistance of the tumor to Palbociclib treatment.
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Affiliation(s)
- Nanzhe Zhong
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Dong Yu
- Center of Translational Medicine, Naval Medical University, Shanghai, China
| | - Minglei Yang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xingyi Lu
- State Key Laboratory of Computer Architecture, Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Qiangzu Zhang
- State Key Laboratory of Computer Architecture, Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Wei Wei
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jian Jiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhi Zhu
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Su Chen
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
| | - Jianru Xiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
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Ullah A, Kenol GS, Lee KT, Yasinzai AQK, Waheed A, Asif B, Khan I, Sharif H, Khan J, Heneidi S, Karki NR, Tareen TK. Chordoma: demographics and survival analysis with a focus on racial disparities and the role of surgery, a U.S. population-based study. Clin Transl Oncol 2024; 26:109-118. [PMID: 37306806 DOI: 10.1007/s12094-023-03227-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Chordoma is a rare malignant tumor of notochordal origin that may appear anywhere in the axial skeleton from the skull base to the sacrum. This study presents findings from a large database query to highlight the demographic, clinical, and pathological factors, prognosis, and survival of chordomas. METHODS The Surveillance, Epidemiology, and End Results (SEER) data based was used to identify patients with a "chordoma" diagnosis from 200 to 2018. RESULTS In a total of 1600 cases, the mean age at diagnosis was 54.47 years (standard deviation, SD ± 19.62 years). Most cases were male (57.1%) and white (84.5%). Tumor size was found to be > 4 cm in 26% of cases. Histologically, 33% with known features had well-differentiated Grade I tumors, and 50.2% of the tumors were localized. Metastasis at the time of to the bone, liver, and lung was observed at a rate of 0.5%, 0.1%, and 0.7%, respectively. The most common treatment received was surgical resection (41.3%). The overall 5-year overall survival observed was 39% (confidence interval, CI 95% 37-41; p = 0.05) with patients who received surgery having a 5-year survival rate of 43% (CI 95% 40-46; p = 0.05). Multivariate analysis showed independent factors that contributed to worse prognosis chemotherapy only as a treatment modality and no surgery as a treatment modality. CONCLUSION Chordomas are more common in white males and appear between the 5th and 6th decades of life. Factors that contributed to a worse prognosis were Asian, Pacific Islander, American Indian, or Alaska Native races.
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Affiliation(s)
- Asad Ullah
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, 37232, USA.
- Department of Pathology and Laboratory Medicine, Vanderbilt University, Nashville, TN, 37232, USA.
| | | | | | | | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA, 95231, USA
| | - Bina Asif
- Bannu Medical College, Bannu, 28100, Pakistan
| | - Imran Khan
- Department of Medicine, Bolan Medical College, Quetta, 83700, Pakistan
| | - Hajra Sharif
- Frontier Medical and Dental College, Abbottabad, Pakistan
| | - Jaffar Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Saleh Heneidi
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Nabin R Karki
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, 36604, USA
| | - Tamour Khan Tareen
- Department of Neurology, Wake Forest Atrium Health, Charlotte, NC, 28203, USA
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Farrokhi MR, Nouraei H, Hosseini SV, Tarokh A, Mousavi SR, Taheri R, Akbarzadeh A, Shahpari Motlagh MA. Sacrectomy with Posterior-Only Approach in Sacral Tumors: An Analysis of 26 Cases and Review of Literature. World Neurosurg 2023; 179:e288-e295. [PMID: 37625639 DOI: 10.1016/j.wneu.2023.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Sacral masses can be removed using anterior, posterior, or combined approaches. Achieving total sacrectomy through a posterior-only approach results in a shorter procedure time, minimal tissue damage, and a reduced risk of complications. In this study, we aimed to share our experience with performing total sacrectomy using a posterior-only approach in 26 patients and to assess their clinical outcomes at our center. MATERIALS AND METHODS This retrospective study examines the clinical progression, surgical response, and outcomes of 26 patients with various sacral mass pathologies. We accessed patient information from our hospital records. RESULTS The study included 14 men (54%) and 12 women (46%), with an average age of 49.8 years. Most cases had a normal body mass index, while 6 were overweight. Sacrectomy was performed at a high level in 12 patients and at a middle level in 14 patients. In addition to pain, motor deficits were observed in 9 patients, and sphincter dysfunction was found in 5. Preoperative embolization was conducted for 11 patients. The most prevalent lesions were chordoma (8 patients), malignant peripheral nerve sheath tumor (4 patients), giant cell tumor (3 patients), and solitary plasmacytoma (3 patients). Only 1 patient experienced a temporary partial motor deficit after surgery. There were no instances of cerebrospinal fluid leakage. Five patients experienced local recurrence, and 1 had distant metastasis. CONCLUSIONS Performing sacrectomy for large or giant sacral tumors through a posterior approach is both feasible and safe, resulting in reduced morbidity and no significant change in overall survival.
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Affiliation(s)
- Majid Reza Farrokhi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hormoz Nouraei
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amir Tarokh
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Reza Mousavi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Taheri
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Wolf RJ, Winkler V, Mattke M, Uhl M, Debus J. Intensity-modulated radiotherapy for the management of primary and recurrent chordomas: a retrospective long-term follow-up study. Rep Pract Oncol Radiother 2023; 28:207-216. [PMID: 37456699 PMCID: PMC10348326 DOI: 10.5603/rpor.a2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/06/2023] [Indexed: 07/18/2023] Open
Abstract
Background Chordomas have a high risk of recurrence. Radiotherapy (RT) is required as adjuvant therapy after resection. Sufficient radiation doses for local control (LC) can be achieved using either particle therapy, if this technology is available and feasible, or intensity-modulated radiotherapy. Materials and methods 57 patients (age, 11.8-81.6 years) with chordomas of the skull base, spine and pelvis who received photon radiotherapy between 1995 and 2017 were enrolled in the study. Patients were treated at the time of initial diagnosis (68.4%) or during recurrence (31.6%). 44 patients received adjuvant radiotherapy and 13 received definitive radiotherapy. The median total dose to the physical target volume was 70 Gy equivalent dose in 2 Gy fractions (EQD2) (range: 54.7-82.5) in 22-36 fractions. Results LC was 76.4%, 58.4%, 46.7% and 39.9% and overall survival (OS) was 98.3%, 89%, 76.9% and 47.9% after 1, 3, 5 and 10 years, respectively, with a median follow-up period of 6.5 years (range, 0.5-24.3 years). Age, dose and treatment concept (post-operative or definitive) were significant prognostic factors for OS. Primary treatment, macroscopic tumour at RT and size of the irradiated volume were statistically significant prognostic factors for LC. Conclusion Photon treatment is a safe and effective treatment for chordomas if no particle therapy is available. The best results can be achieved against primary tumours if the application of curative doses is possible due to organs at risk in direct proximity. We recommend high-dose radiotherapy, regardless of the resection status, as part of the initial treatment of chordoma, using the high conformal radiation technique if particle therapy is not feasible.
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Affiliation(s)
- Robert J. Wolf
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Volker Winkler
- Institute of Public Health, Unit of Epidemiology and Biostatistics, University of Heidelberg, Heidelberg, Germany
| | - Matthias Mattke
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Matthias Uhl
- Department of Radiation Oncology, Ludwigshafen City Hospital, Ludwigshafen, Germany
| | - Jürgen Debus
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- German Cancer Research Center (dkfz), Heidelberg, Germany
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Murphey MD, Minn MJ, Contreras AL, Koeller KK, Shih RY, Inwards CY, Yamaguchi T. Imaging of spinal chordoma and benign notochordal cell tumor (BNCT) with radiologic pathologic correlation. Skeletal Radiol 2023; 52:349-363. [PMID: 36063190 DOI: 10.1007/s00256-022-04158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
Benign notochordal cell tumor (BNCT) and chordoma are neoplasms of notochordal differentiation. BNCT represents notochordal rests, commonly an incidental lesion present in the spine in 19% of cadaveric specimens. BNCTs are often radiographically occult. CT of BNCT frequently reveals patchy sclerosis between areas of maintained underlying trabeculae. BNCT demonstrates marrow replacement on T1-weighted MR images with high signal intensity on T2-weighting. BNCTs are frequently smaller than 35 mm and lack significant enhancement, bone destruction, cortical permeation, or soft tissue components. Biopsy or surgical resection of BNCT is usually not warranted, although imaging surveillance may be indicated. Chordoma is a rare low-grade locally aggressive malignancy representing 1-4% of primary malignant bone tumors. Chordoma is most frequent between the ages of 50-60 years with a male predilection. Clinical symptoms, while nonspecific and location dependent, include back pain, numbness, myelopathy, and bowel/bladder incontinence. Unfortunately, lesions are often large at presentation owing to diagnosis delay. Imaging of chordoma shows variable mixtures of bone destruction and sclerosis, calcification (50-70% at CT) and large soft tissue components. MR imaging of chordoma reveals multilobulated areas of marrow replacement on T1-weighting and high signal intensity on T2-weighting reflecting the myxoid component within the lesion and areas of hemorrhage seen histologically. Treatment of chordoma is primarily surgical with prognosis related to resection extent. Unfortunately, complete resection is often not possible (21-75%) resulting in high local recurrence incidence (19-75%) and a 5-year survival rate of 45-86%. This article reviews and illustrates the clinical characteristics, pathologic features, imaging appearance spectrum, treatment, and prognosis of BNCT and spinal chordoma.
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Affiliation(s)
- Mark D Murphey
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA. .,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA. .,Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA.
| | - Matthew J Minn
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA.,Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA.,Department of Radiology, Scripps Green Hospital, 10666 N. Torrey Pines Road, La Jolla, CA, 92037, USA
| | | | - Kelly K Koeller
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA.,Department of Radiology, Head and Neck Cancer Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert Y Shih
- Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA
| | - Carrie Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Takehiko Yamaguchi
- Department of Pathology, Nikko Medical Center, Dokkyo Medical University, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
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Pinter ZW, Moore EJ, Rose PS, Nassr AN, Currier BL. En bloc resection of a high cervical chordoma followed by reconstruction with a free vascularized fibular graft: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22305. [PMID: 36536523 PMCID: PMC9764371 DOI: 10.3171/case22305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Wide excision of chordoma provides better local control than intralesional resection or definitive radiotherapy. The en bloc excision of high cervical chordomas is a challenging endeavor because of the complex anatomy of this region and limited reconstructive options. OBSERVATIONS This is the first case report to describe reconstruction with a free vascularized fibular graft following the en bloc excision of a chordoma involving C1-3. LESSONS This report demonstrates the durability of this construct at 10-year follow-up and is the first case report demonstrating satisfactory long-term oncological outcomes after a true margin-negative resection of a high cervical chordoma.
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Affiliation(s)
| | - Eric J. Moore
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Ahmad N. Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
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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.
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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
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Sacral Resections for Primary Sacral Tumor — an Experience from a Tertiary Care Cancer Center in India. Indian J Surg Oncol 2022. [DOI: 10.1007/s13193-021-01454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Farshad M, Selman F, Burkhard MD, Müller D, Spirig JM. Partial sacrectomy with patient-specific osteotomy guides. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 8:100090. [PMID: 35141654 PMCID: PMC8820056 DOI: 10.1016/j.xnsj.2021.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Background Chordomas are rare, locally aggressive, malignant tumors. Surgical resection with sufficient margins defines the outcome. However, the necessity for wide margins often leads to sacrifice of important neurological structures. 3D-printed osteotomy guides are a promising solution for precise execution of surgical resection. We present probably the first sacrococcygeal chordoma resection with 3D-printed guides. Methods The case of a 49-year-old woman with a sacrococcygeal chordoma, resected with help of 3-D pre-operative planning and patient-specific 3D-printed osteotomy guides, is reported in detail. Results A sufficient tumor excision could be performed successfully while sparing nerve root S4. The planed margin has been exactly maintained, as confirmed by histology. The patient demonstrated an excellent clinical outcome with no evidence of local recurrence. Conclusions 3-D pre-operative planning and patient-specific osteotomy guides can be used for planning and performing en-bloc surgical resection of sacral chordomas.
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Affiliation(s)
- Mazda Farshad
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Farah Selman
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Marco D Burkhard
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Daniel Müller
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - José Miguel Spirig
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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11
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Garcia Mora M, Mariño IF, Puerto Horta LJ, Gonzalez F, Diaz Casas S. The Surgical Approach Combined With Minimally Invasive Surgery for Sacral Chordoma. Cureus 2021; 13:e18690. [PMID: 34786264 PMCID: PMC8580643 DOI: 10.7759/cureus.18690] [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] [Accepted: 10/09/2021] [Indexed: 11/05/2022] Open
Abstract
Sacral chordomas are malignant, locally aggressive, and rare tumors. Its presentation can be diverse on the entire spine, being more frequent in the sacrococcygeal region. The main treatment is complete surgical resection, which can be performed using different approaches depending on the case. We present the case of a 44-year-old woman with a history of a complex adnexal mass, with an imaging finding of a presacral mass displacing the uterus and rectum, with a histological report of an image-guided biopsy suggestive of a soft-tissue myoepithelioma-like tumor, which was managed with a combined approach: anterior transabdominal laparoscopic and posterior approach, achieving complete tumor resection, without postoperative complications and with the benefits of minimally invasive surgery. The pathology report of the surgical piece was compatible with sacral chordoma.
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Affiliation(s)
- Mauricio Garcia Mora
- Breast and Soft Tissue Surgery, Instituto Nacional de Cancerología, Bogotá D.C., COL
| | - Ivan Fernando Mariño
- Breast and Soft Tissue Surgery, Instituto Nacional de Cancerología, Bogota D.C., COL
| | | | - Felipe Gonzalez
- Breast and Soft Tissue Surgery, Instituto Nacional de Cancerología, Bogotá D.C., COL
| | - Sandra Diaz Casas
- Breast and Soft Tissue Surgery, Instituto Nacional de Cancerología, Bogotá D.C., COL
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12
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Baig Mirza A, Bartram J, Okasha M, Al Banna Q, Vastani A, Maratos E, Gullan R, Thomas N. Surgical Management of Spinal Chordoma: A Systematic Review and Single-Center Experience. World Neurosurg 2021; 156:e111-e129. [PMID: 34506978 DOI: 10.1016/j.wneu.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. The importance of wide margins and use of adjuvant therapy in spinal chordomas are still contentious points in the management of spinal chordomas. We conducted a systematic review of the surgical management of spinal chordomas alongside our 10-year institutional experience. METHODS A systematic search of the literature was performed in November 2020 using Embase and MEDLINE for articles regarding the surgical management of chordomas arising from the mobile spine and sacrum. We also searched for all adult patients who were surgically managed for spinal chordomas at our institute between 2010 and 2020. In both the systematic review and our institutional case series, data on adequacy of resection, use of adjuvant therapy, complications, recurrence (local or metastatic), and survival outcomes were collected. RESULTS We identified and analyzed 42 articles, yielding 1531 patients, from which the overall gross total or wide resection rate was 54.9%. Among the 8 cases in our institutional experience (4 sacral, 3 cervical, and 1 lumbar), we achieved gross total resection in 50% of initial operations. The recurrence rate was 25% in our gross total resection group and 50% where initial resection was subtotal. Of patients, 75% had no evidence of recurrence at most recent follow-up. CONCLUSIONS Albeit difficult at times because of the proximity to neurovascular tissue, achieving a wide resection followed by adjuvant therapy for spinal chordomas is of great importance. Multidisciplinary discussion is valuable to ensure the best outcome for the patient.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mohamed Okasha
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Qusai Al Banna
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Eleni Maratos
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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13
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Zhang GJ, Cui YS, Li H. Survival and treatment of cranial and spinal chordomas: a population-based study. Neurosurg Rev 2021; 45:637-647. [PMID: 34156550 DOI: 10.1007/s10143-021-01583-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 02/08/2023]
Abstract
Chordomas are rare, slow-growing malignant tumors. Given the paucity of data of the disease, the treatment strategies are disputed. We collected clinical and survival information of patients with chordoma diagnosed between 1975 and 2016 from the Surveillance, Epidemiology, and End Results database. A total of 1797 patients were initially enrolled, including 762 (42.4%) cranial and 1035 (57.6%) spinal chordoma. A total of 1504 patients were further evaluated after screening. In the cranial group, the surgery (gross total resection (GTR): p = 0.001 for overall survival (OS); p = 0.009 for cancer-specific survival (CSS)), tumor extension (distant metastasis: p = 0.001 for OS; p = 0.002 for CSS), and the age (p < 0.001 for OS) were independent prognostic factors for survival. In the spinal group, the age (p = 0.004), location (p < 0.001), GTR (p < 0.001), and tumor extension (distant metastasis, p < 0.001) were independent prognostic factors for OS; the age (p = 0.007), histological type (p < 0.001), GTR (p < 0.001), radiation (p = 0.018), chemotherapy (p = 0.006), and tumor extension (p < 0.001) were independent prognostic factors for CSS. In this large cohort, a significant association was noted between extent of resection and outcome. Even though adjuvant radiation or chemotherapy did not benefit patients with chordoma, the effect on prognosis can be explored in a further study based on our findings.
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Affiliation(s)
- Gui-Jun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu-Shi Cui
- Department of Orthopedic, Beijing Hospital of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine, Chaoyang District, Beijing, CN100029, China
| | - Huan Li
- Department of Neurosurgery, Fengtai District, Beijing Tiantan Hospital Nansihuanxilu 119, Beijing, 100070, China.
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14
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Solitary Subcutaneous Nodule on the Eyelid: Answer. Am J Dermatopathol 2021; 43:310-311. [PMID: 33743000 DOI: 10.1097/dad.0000000000001673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Beddok A, Saint-Martin C, Mammar H, Feuvret L, Helfre S, Bolle S, Froelich S, Goudjil F, Zefkili S, Amessis M, Peurien D, Cornet S, Dendale R, Alapetite C, Calugaru V. High-dose proton therapy and tomotherapy for the treatment of sacral chordoma: a retrospective monocentric study. Acta Oncol 2021; 60:245-251. [PMID: 33095672 DOI: 10.1080/0284186x.2020.1834140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Radiation therapy (RT) is used for the treatment of sacral chordoma, in combination with surgery or alone for unresected tumours, to improve local control (LC) and potentially overall survival (OS). The purpose of the present study was to evaluate efficacy and toxicity of proton therapy (PT), and/or intensity modulated radiation therapy (IMRT), particularly Tomotherapy, for sacral chordoma treatment. Material: Between November 2005 and June 2018, 41 consecutive patients who were not included in clinical trials, received sacral chordoma radiation treatment in Institut Curie with Tomotherapy alone in 13 patients, and combined PT and Tomotherapy boost (Proton - Tomo) in 28 patients. RT was delivered as the exclusive local treatment in 11 patients, and as a post-operative complementary treatment in 30 patients. RESULTS After a median follow-up of 46 months (range, 0-125 months), eight local relapses were observed, and seven patients developed distant metastasis (particularly bone and lung). The 2- and 5- year local relapse rates were 11.4% CI (0.65-22.2%) and 29% (10.5-47.4%), respectively. Over the follow-up period, ten patients died (24.4%). The estimated 2- and 5-year OS rates were 91.4% CI (82.5-100%) and 74.5% (59.4-93.5%), respectively. Fibrosis, cauda equina syndrome, and pain were the most common late toxicities. The comparison between Tomotherapy alone and Proton - Tomo revealed that acute and late cystitis were significantly more frequent in the Tomotherapy group: SHR = 0.12 IC95% (0.01-0.90 [p = .04]), as well as late proctitis. A dosimetric comparison confirmed the interest of PT to spare rectum and bladder in this context. CONCLUSION RT remains essential to improve local control in sacral chordoma. The combination of proton and photon seems to improve organ at risk sparing, resulting in a decreased rate of reported late toxicities.
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Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation oncology, Curie Institute, Paris, France
| | | | - Hamid Mammar
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation oncology, Curie Institute, Paris, France
| | - Loïc Feuvret
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation Oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - Sylvie Helfre
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation oncology, Curie Institute, Paris, France
| | - Stéphanie Bolle
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | | | - Farid Goudjil
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
| | - Sofia Zefkili
- Department of Radiation oncology, Curie Institute, Paris, France
| | - Malika Amessis
- Department of Radiation oncology, Curie Institute, Paris, France
| | | | - Sophie Cornet
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
| | - Rémi Dendale
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation oncology, Curie Institute, Paris, France
| | - Claire Alapetite
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation oncology, Curie Institute, Paris, France
| | - Valentin Calugaru
- Department of Radiation Oncology, Proton Therapy Centre, Curie Institute, Orsay, France
- Department of Radiation oncology, Curie Institute, Paris, France
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16
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Konieczkowski DJ, DeLaney TF, Yamada YJ. Radiation Strategies for Spine Chordoma: Proton Beam, Carbon Ions, and Stereotactic Body Radiation Therapy. Neurosurg Clin N Am 2020; 31:263-288. [PMID: 32147017 DOI: 10.1016/j.nec.2019.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgery alone provides suboptimal local control of spine and sacral chordomas. Radiotherapy (RT) may improve local control in patients undergoing surgery and be used as definitive-intent treatment in patients not undergoing surgery. Although conventional-dose RT is inadequate for these radioresistant tumors, newer techniques allow treatment of the tumor to higher, more effective doses while limiting spinal cord dose to safe levels. The best local control is achieved when RT is delivered in the primary setting; RT dose is a critical determinant of local control. RT should be considered for all spine and sacral chordoma patients.
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Affiliation(s)
- David J Konieczkowski
- Harvard Radiation Oncology Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Yoshiya Josh Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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17
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Brown KG, Lee PJ. Algorithms for the surgical management of benign and malignant presacral tumors. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Connors SW, Aoun SG, Shi C, Peinado-Reyes V, Hall K, Bagley CA. Recent advances in understanding and managing chordomas: an update. F1000Res 2020; 9. [PMID: 32724558 PMCID: PMC7366033 DOI: 10.12688/f1000research.22440.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 12/20/2022] Open
Abstract
Chordomas are rare and difficult-to-treat tumors arising from the embryonic notochord. While surgery is the mainstay of treatment, and despite new techniques aimed at maximizing total tumoral resection, recurrence remains high and the probability of disease-free survival low. New breakthroughs in genetics, targeted molecular therapy, and heavy-particle beam therapy offer some promise as adjuvant treatments in addition to surgical resection. A multidisciplinary approach encompassing genetics, immunotherapy, radiation therapy, and surgery, at a facility experienced in the management of this complex disease, offers the best chance of survival and quality of life to patients while limiting the intrinsic morbidity of these treatments.
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Affiliation(s)
- Scott W Connors
- Department of Neurological Surgery, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern School of Medicine, Dallas, TX, USA.,UT Southwestern Spine Center, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Chen Shi
- Department of Neurological Surgery, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Valery Peinado-Reyes
- Department of Neurological Surgery, University of Texas Southwestern School of Medicine, Dallas, TX, USA.,UT Southwestern Spine Center, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern School of Medicine, Dallas, TX, USA.,UT Southwestern Spine Center, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern School of Medicine, Dallas, TX, USA.,UT Southwestern Spine Center, University of Texas Southwestern School of Medicine, Dallas, TX, USA.,Department of Orthopedic Surgery, University of Texas Southwestern School of Medicine, Dallas, TX, USA
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19
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Yang Y, Li Y, Zhang Q, Niu X. A case-control study of computer navigation assisted resection of primary sacral chordoma above sacrum 3 level. J Bone Oncol 2020; 23:100303. [PMID: 32637303 PMCID: PMC7326737 DOI: 10.1016/j.jbo.2020.100303] [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: 04/19/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022] Open
Abstract
This is a retrospective case-control study. The computer navigation aided technology can make more cases achieve safe surgical margin. The clear bone resection margins were achieved in all cases in navigation group. The application of computer navigation doesn’t increase the operation time and intraoperative blood loss.
Background The operation of sacral chordoma resection is difficult especial in the tumor above sacrum 3 level and the local recurrence rate was high. The purpose of this study is to analyze the effect of computer navigation aided technology in primary sacral chordoma resection above sacrum 3 level through a case-control study, which including perioperative safety, surgical margin, postoperative recurrence and function results. Methods This is a retrospective case-control study. The clinical data of 25 patients received initial computer-assisted resection of sacral chordoma above the level of sacrum 3 from 2009 to 2016 were analyzed; the patients underwent non-navigation assisted resection of tumor above the level of sacrum 3 in the same period were matched and 25 patients were selected randomly. There was no significant difference between these two groups in gender (P = 0.370), age (P = 0.554), tumor transverse diameter (P = 0.836). The average maximum diameter of tumor in navigation group was significant bigger than that in non-navigation group (P = 0.005). The intraoperative safety results, surgical margin, postoperative complications, recurrence rate and function were compared between these groups. Results There was no significant difference between navigation and non-navigation group in operative time (P = 0.105) and intraoperative blood loss (P = 0.537). There were 18 wide resections, 4 marginal resections and 3 intracapsular resections in navigation group; there were 6 wide resections, 12 marginal resections and 7 intracapsular resections in non-navigation group; the surgical margins of two groups were significant different (P = 0.003). There were 5 cases (20%) and 6 cases (24%) with wound complication in navigation group and non-navigation group (P = 0.733). The average follow-up was 49.6 (16–102) months in navigation group and 51.3 (12–110) months in non-navigation group. Three cases (12%) showed recurrence in navigation group and six cases showed recurrence (24%) in non-navigation group. The surgical margin was significantly related with tumor recurrence (P = 0.000). The average MSTS score was 27.3 (19–30) and 26.5 (20–29) in navigation group and non-navigation group (P = 0.374). Conclusion The computer navigation aided technology can improve the accuracy of primary sacral chordoma resection, and make more cases achieve safe surgical margin. Compared with the traditional operation, the application of computer navigation in the larger tumor resection does not increase the operation time and intraoperative blood loss, which shows good safety.
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Affiliation(s)
- Yongkun Yang
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking, University, Beijing, People's Republic of China
| | - Yuan Li
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking, University, Beijing, People's Republic of China
| | - Qing Zhang
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking, University, Beijing, People's Republic of China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking, University, Beijing, People's Republic of China
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Zhang Y, Chen WG, Yang SZ, Qiu H, Sun J, Hu X, Liao TQ, Yang L, Liu YG, Chu TW. Preliminary investigation of bilateral internal iliac artery ligation and anterior tumor separation through laparoscopy before posterior resection of a giant sacral tumor. Surg Oncol 2020; 34:24-30. [PMID: 32891337 DOI: 10.1016/j.suronc.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/26/2020] [Accepted: 03/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical is the optimal therapeutic strategy for sacral tumors, and complete resection can effectively improve the recurrence and survival rates. However, the specialized anatomy, massive bleeding and adhesion to the anterior tissue, especially that caused by giant sacral tumors, makes complete resection difficult. The laparoscopic technique provides a new method to resect sacral tumors. METHODS 34 patients with primary giant sacral tumors who underwent surgical resection were enrolled. After bilateral internal iliac artery ligation and anterior laparoscopic tumor separation, the sacral tumors were successfully resected posteriorly. The clinical, radiological and follow-up data were collected and analyzed. RESULTS The average operative time was 276.47 min and that for laparoscopy was 76.24 min. The average intraoperative blood loss was 1757.64 ml. No complications associated with laparoscopic surgery, such as intestinal, urinary tract, or vascular injuries, occurred. Ten patients (29.41%) had perioperative complications, including infection, unhealed wounds, and cerebrospinal fluid leaks in 10, 5 and 2 patients, respectively. Patients with complications had significantly longer total (55.00 ± 34.53 vs 25.13 ± 14.60, P = 0.001) and postoperative (39.10 ± 30.61 vs 14.83 ± 10.00, P = 0.002) hospitalization stays than patients without complications. Postoperatively, bowel and bladder dysfunction, intestinal obstruction, pain, and perianal numbness occurred in 21, 5, 8, and 2 patients, respectively. The recurrence rate was 11.76%. CONCLUSIONS Laparoscopically assisted sacral tumor resection is a technically feasible and effective surgical method to resect giant sacral tumors, with the advantages of reduced operative blood loss during internal iliac artery ligation and anterior tumor separation.
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Affiliation(s)
- Ying Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Wu-Gui Chen
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Si-Zhen Yang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Hao Qiu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Jing Sun
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Xu Hu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Tong-Quan Liao
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Ling Yang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Yu-Gang Liu
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 400037, China; Department of Orthopedics, The Ninth People's Hospital Of Chongqing, Chongqing, 400037, China
| | - Tong-Wei Chu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
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Xu G, Liu C, Liang T, Zhang Z, Jiang J, Chen J, Xue J, Zeng H, Lu Z, Zhan X. Gene expression profile and bioinformatics analysis revealed key molecular characteristics of chordoma-before and after TNF- a treatment. Medicine (Baltimore) 2020; 99:e18790. [PMID: 32011476 PMCID: PMC7220412 DOI: 10.1097/md.0000000000018790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/16/2019] [Accepted: 12/16/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Chordoma is a rare malignant tumor with limited treatment. Recent studies have shown that the proliferation and invasion ability of chordoma after Tumor necrosis factor alpha (TNF-α) treatment is enhanced, which may activate the gene pathway involved in the development of chordoma. This study tends to identify differentially expressed genes (DEGs) before and after treatment of TNF-α in chordoma cell line, providing a new target for future molecular therapy of chordoma. METHODS The gene expression profile of GSE101867 was downloaded from the Gene Expression Omnibus database, and the differentially expressed genes were obtained using GEO2R. Based on the CLUEGO plugin in Cytoscape, DEGs functionality and enrichment analysis. A protein-protein interaction (PPI) network was constructed using Cytoscape based on data collected from the STRING online dataset. The Hub genes are selected from the CytoHubba, the first 20 genes that coexist with the KEGG tumor-related pathway. RESULTS A total of 560 genes, including 304 up-regulated genes and 256 down-regulated genes, were selected as DEGs. Obviously, GO analysis shows that up-regulated and down-regulated DEGs are mainly enriched in biological processes such as synaptic tissue, cell adhesion, extracellular matrix organization and skeletal system development. DEGs are mainly enriched in tumor-associated pathways such as Pi3k-akt Signal path, Rap1 signal path. Three key genes were identified: PDGFRB, KDR, FGF2. All of these genes are involved in the tumor-associated pathways described previously. CONCLUSION This study is helpful in understanding the molecular characteristics of chordoma development. Hub genes PDGFRB, KDR, FGF2 and pi3k-akt signaling pathway, Rap1 signaling pathway will become a new target for the future treatment of chordoma.
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Affiliation(s)
| | - Chong Liu
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
| | | | | | | | | | | | | | | | - Xinli Zhan
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
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22
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Yamamoto N, Tsuchiya H. Treatment of chordoma-where is it going? JOURNAL OF SPINE SURGERY 2019; 5:387-389. [PMID: 31663053 DOI: 10.21037/jss.2019.09.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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