112. Surgical treatment of primary mobile spine chordomas

Abstract

<h3>BACKGROUND CONTEXT</h3> Chordoma of the mobile spine (C1-L5) is a rare, locally aggressive tumor with the ability to metastasize. Data examining outcomes of primary surgical resection with or without adjuvant treatment of mobile spine chordomas are currently scarce. <h3>PURPOSE</h3> The purpose of this study was to review the overall survival, local recurrence, and distant metastasis of all patients receiving surgical treatment of a primary mobile spine chordoma. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series. <h3>PATIENT SAMPLE</h3> All patients (34) undergoing surgical excision of a primary mobile spine chordoma. <h3>OUTCOME MEASURES</h3> Patient and oncologic outcomes including, patient survival, disease specific survival, local and distant recurrence, complications, and need for revision surgery. <h3>METHODS</h3> Over a 29-year period (1990-2019), 34 primary mobile spine chordomas were treated with surgical resection at our institution. Of those, 21 (60%) were males, at a mean age of 57±18 years, and mean BMI of 29±7.1 kg/m². Tumor location included cervical (n=16, 47%), thoracic (n=3, 9%) and lumbar (n=15, 44%) spine. Eighteen (53%) patients presented with a pathological fracture. The mean maximal tumor dimension was 5±3 cm, with a mean tumor volume of 140±424 cm³. The final resection margin was considered positive in 15 (44%) patients. Radiotherapy was used in 23 (68%) patients to assist with margin control. Mean follow-up was 7 years (up to 22 years). <h3>RESULTS</h3> Following surgical resection, the mean 2-, 5- and 10-year survival was 86%, 60% and 46% respectively. There was no difference (p=0.96) in the 5-year overall survival between patients with cervical (61%), thoracic (66%) and lumbar (58%) spine tumors. Local tumor recurrence was associated with death due to disease (HR 3.39, 95% CI 1.16-9.87, p=0.02). Tumor recurrence occurred in 17 (50%) patients and defined as local only (n=8, 24%), distant only (n=4, 12%) and local and distant (n=5, 15%). The 2-, 5- and 10-year local recurrence free survival was 78%, 59% and 46%. Local recurrence free survival was improved in patients receiving en bloc resection with negative margins (83% vs 35%, p=0.02) and similar in patients receiving adjuvant radiation therapy (43% vs 45%, p=0.30) at 10 years. A positive surgical margin (HR 16.17, 95% CI 2.05-127.53, p<0.008) was associated with local tumor recurrence. The 2-, 5- and 10-year distant disease recurrence free survival was 85%, 73% and 66%. Larger tumor size (>140 cm³) was associated with metastatic disease (HR 9.20, 95% CI 1.53-55.21, p=0.01). Following resection, complications occurred in 30 (88%) patients, leading to a reoperation in 13 (38%) patients. The most common indication for reoperation was for failure of surgical hardware (n=5, 15%). <h3>CONCLUSIONS</h3> Surgical resection of mobile spine chordomas is associated with a high rate of complications; however, en bloc resection can provide a hope for cure and appears to confer better oncologic outcomes for these tumors without an increase in complications compared to lesser resections. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.