Results following surgical resection of recurrent chordoma of the spine: experience in a single institution

Pongsthorn Chanplakorn,Wichien Laohacharoensombat,Prakrit Suwanpramote,Wittawat Homcharoen,Thamrong Lertudomphonwanit

doi:10.1186/s12957-020-02005-4

Pongsthorn Chanplakorn, Wichien Laohacharoensombat + Show 3 more

Open Access

https://doi.org/10.1186/s12957-020-02005-4

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Abstract

BackgroundChordoma 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 methodsRetrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018 at one tertiary-care center was conducted.ResultsThere 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.ConclusionEn-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.

Highlights

Chordomas are relatively rare, slow-growing, primary malignant bone tumors and comprise 17.5% of axial primary malignant bone tumors [1]
The first treatment guideline for locally recurrent chordoma has been proposed by Chordoma Global Consensus Group in 2017 [9] and recommended the surgical treatment as one of the option, if possible, determined by the surgical plane, surrounding soft tissue, disability, comorbidity, and expected survival especially when highdose radiation is not possible or available
A retrospective review was conducted; the patients who were diagnosed for chordoma of the spine and underwent surgical treatment by two senior spine surgeons between 2003 and 2018 at our institution were enrolled in this study

Summary

Introduction

Slow-growing, primary malignant bone tumors and comprise 17.5% of axial primary malignant bone tumors [1]. Because of their indolent and low-grade nature, chordoma is typically diagnosed at a late stage and often cause significant damage and compromise neurologic structures. The goal of treatment is to achieve surgical en-bloc excision with tumor-free margins to maximize local tumor control and overall. 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

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