Wednesday, September 26, 2018 2:00 PM – 3:00 PM Improving Quality of Life for Patients with Tumors: 78. Optimal treatment strategy for newly diagnosed chordoma of the spine: results of an international survey to design a prospective cohort study

Abstract

BACKGROUND CONTEXT Treatment strategies for spinal chordomas are heterogeneous and are mainly driven by institutional biases and local protocols. Surgery plays a central role in their management but the extent of surgery and the role of adjuvant therapy, particularly radiation therapy, is not standard across centers. PURPOSE The aims of this international collaborative effort are to identify the main management options for newly diagnosed chordoma of the spine, understand the variations in treatment protocols among experienced centers, and to consequently design a multicenter prospective cohort study to help determine the best multimodal treatment for this patient population. STUDY DESIGN/SETTING A survey was distributed to 39 spinal oncology specialists in neurosurgery, orthopedic surgery, and radiation oncology from 29 centers. METHODS Two clinical scenarios were presented and the preferred management strategy was queried among the respondents: (1) a newly diagnosed chordoma of the spine when en bloc resection is feasible with acceptable morbidity, and (2) when en bloc resection is not feasible as it would result in significant morbidity. Based on the results of this survey, a prospective cohort study combining centers with similar treatment strategies for newly diagnosed chordoma of the spine is proposed. RESULTS When en bloc resection is feasible with acceptable morbidity, most participants (79.5%) favored an en bloc resection without preoperative neo-adjuvant radiation treatment (RT). The main disagreement is with the role of postoperative radiation with 41% giving RT only if positive margins and 38% giving adjuvant RT to everyone irrespective of marginal status. When en bloc resection would result in significant morbidity, results were more evenly distributed and 33% of respondents preferred to do a deliberate intralesional resection followed by RT, and 33% chose to give neo-adjuvant RT prior to surgery. By combining centers with similar philosophies, three distinct treatment cohorts were identified for tumors for which en bloc resection is feasible with acceptable morbidity and 5 treatment groups for tumors in which en bloc resection would result in significant morbidity. These will constitute the distinct treatment cohorts of a prospective international cohort study. CONCLUSIONS The results of this survey allowed the design of an international collaborative prospective cohort study to uncover the best treatment strategy for patient with spinal chordomas. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.