Sacrectomy and adjuvant radiotherapy for the treatment of sacral chordomas

A single-center experience over 27 years

Arjun A. Dhawale, Joseph Gjolaj, Laurens Holmes, Laurence Sands, H. Thomas Temple, Frank J Eismont

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

STUDY DESIGN.: Retrospective cohort (case only). OBJECTIVE.: To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy. SUMMARY OF BACKGROUND DATA.: There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood. METHODS.: Demographics, treatment, complications, and oncological outcomes were analyzed with summary statistics, hypothesis testing with Mantel-Haenszel-Cox analysis, log-rank test, Cox proportional hazard model, and Kaplan-Meier survival estimates as applicable. RESULTS.: There were 12 males and 9 females with mean age of 61 years (16-79) and mean follow-up of 5.8 years (2-19.2). Tumor stage was IB in 20 and IIIB in one; mean tumor size was 10.5 cm. Fourteen patients underwent combined anterior-posterior resection and 7 posterior resection alone; 18 received adjuvant radiotherapy. After treatment, bowel and bladder control were present in 4 and 5 patients, respectively. Complications included: wound infection (4), other wound complications (9), fistula (2), deep vein thrombosis (1), and pulmonary embolism (1). Median survival was 7.2 years. Eight (40%) had local recurrence and 4 (19%) metastatic disease. Mean disease-free interval before recurrence was 2.5 years (1-5). No patient (n = 8) treated in the past 9 years has had local or distant disease. Patients treated for recurrent tumor survived 5.7 years on average (range, 0.8-9) after the first recurrence. The only risk factor for tumor recurrence was proximal tumor extent (P = 0.05) There was a statistically significant association between recurrence and survival (RR = 3.8; 95% confidence interval, 1.0-15.3; P = 0.04). CONCLUSION.: Despite the complications, increased long-term survival can be achieved with treatment. Proximal tumor extent may be related to recurrence and survival. Recurrence rates have diminished over time, emphasizing the importance of an experienced multidisciplinary surgical team.Level of Evidence: N/A

Original languageEnglish
JournalSpine
Volume39
Issue number5
DOIs
StatePublished - Mar 1 2014

Fingerprint

Chordoma
Adjuvant Radiotherapy
Recurrence
Survival
Neoplasms
Therapeutics
Kaplan-Meier Estimate
Wound Infection
Pulmonary Embolism
Proportional Hazards Models
Venous Thrombosis
Fistula
Urinary Bladder
Demography
Confidence Intervals
Wounds and Injuries

Keywords

  • chordoma
  • complications
  • en bloc resection
  • oncological
  • outcomes
  • radiotherapy
  • recurrence
  • sacrum
  • survival
  • tumor

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Sacrectomy and adjuvant radiotherapy for the treatment of sacral chordomas : A single-center experience over 27 years. / Dhawale, Arjun A.; Gjolaj, Joseph; Holmes, Laurens; Sands, Laurence; Thomas Temple, H.; Eismont, Frank J.

In: Spine, Vol. 39, No. 5, 01.03.2014.

Research output: Contribution to journalArticle

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abstract = "STUDY DESIGN.: Retrospective cohort (case only). OBJECTIVE.: To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy. SUMMARY OF BACKGROUND DATA.: There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood. METHODS.: Demographics, treatment, complications, and oncological outcomes were analyzed with summary statistics, hypothesis testing with Mantel-Haenszel-Cox analysis, log-rank test, Cox proportional hazard model, and Kaplan-Meier survival estimates as applicable. RESULTS.: There were 12 males and 9 females with mean age of 61 years (16-79) and mean follow-up of 5.8 years (2-19.2). Tumor stage was IB in 20 and IIIB in one; mean tumor size was 10.5 cm. Fourteen patients underwent combined anterior-posterior resection and 7 posterior resection alone; 18 received adjuvant radiotherapy. After treatment, bowel and bladder control were present in 4 and 5 patients, respectively. Complications included: wound infection (4), other wound complications (9), fistula (2), deep vein thrombosis (1), and pulmonary embolism (1). Median survival was 7.2 years. Eight (40{\%}) had local recurrence and 4 (19{\%}) metastatic disease. Mean disease-free interval before recurrence was 2.5 years (1-5). No patient (n = 8) treated in the past 9 years has had local or distant disease. Patients treated for recurrent tumor survived 5.7 years on average (range, 0.8-9) after the first recurrence. The only risk factor for tumor recurrence was proximal tumor extent (P = 0.05) There was a statistically significant association between recurrence and survival (RR = 3.8; 95{\%} confidence interval, 1.0-15.3; P = 0.04). CONCLUSION.: Despite the complications, increased long-term survival can be achieved with treatment. Proximal tumor extent may be related to recurrence and survival. Recurrence rates have diminished over time, emphasizing the importance of an experienced multidisciplinary surgical team.Level of Evidence: N/A",
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AU - Dhawale, Arjun A.

AU - Gjolaj, Joseph

AU - Holmes, Laurens

AU - Sands, Laurence

AU - Thomas Temple, H.

AU - Eismont, Frank J

PY - 2014/3/1

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N2 - STUDY DESIGN.: Retrospective cohort (case only). OBJECTIVE.: To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy. SUMMARY OF BACKGROUND DATA.: There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood. METHODS.: Demographics, treatment, complications, and oncological outcomes were analyzed with summary statistics, hypothesis testing with Mantel-Haenszel-Cox analysis, log-rank test, Cox proportional hazard model, and Kaplan-Meier survival estimates as applicable. RESULTS.: There were 12 males and 9 females with mean age of 61 years (16-79) and mean follow-up of 5.8 years (2-19.2). Tumor stage was IB in 20 and IIIB in one; mean tumor size was 10.5 cm. Fourteen patients underwent combined anterior-posterior resection and 7 posterior resection alone; 18 received adjuvant radiotherapy. After treatment, bowel and bladder control were present in 4 and 5 patients, respectively. Complications included: wound infection (4), other wound complications (9), fistula (2), deep vein thrombosis (1), and pulmonary embolism (1). Median survival was 7.2 years. Eight (40%) had local recurrence and 4 (19%) metastatic disease. Mean disease-free interval before recurrence was 2.5 years (1-5). No patient (n = 8) treated in the past 9 years has had local or distant disease. Patients treated for recurrent tumor survived 5.7 years on average (range, 0.8-9) after the first recurrence. The only risk factor for tumor recurrence was proximal tumor extent (P = 0.05) There was a statistically significant association between recurrence and survival (RR = 3.8; 95% confidence interval, 1.0-15.3; P = 0.04). CONCLUSION.: Despite the complications, increased long-term survival can be achieved with treatment. Proximal tumor extent may be related to recurrence and survival. Recurrence rates have diminished over time, emphasizing the importance of an experienced multidisciplinary surgical team.Level of Evidence: N/A

AB - STUDY DESIGN.: Retrospective cohort (case only). OBJECTIVE.: To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy. SUMMARY OF BACKGROUND DATA.: There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood. METHODS.: Demographics, treatment, complications, and oncological outcomes were analyzed with summary statistics, hypothesis testing with Mantel-Haenszel-Cox analysis, log-rank test, Cox proportional hazard model, and Kaplan-Meier survival estimates as applicable. RESULTS.: There were 12 males and 9 females with mean age of 61 years (16-79) and mean follow-up of 5.8 years (2-19.2). Tumor stage was IB in 20 and IIIB in one; mean tumor size was 10.5 cm. Fourteen patients underwent combined anterior-posterior resection and 7 posterior resection alone; 18 received adjuvant radiotherapy. After treatment, bowel and bladder control were present in 4 and 5 patients, respectively. Complications included: wound infection (4), other wound complications (9), fistula (2), deep vein thrombosis (1), and pulmonary embolism (1). Median survival was 7.2 years. Eight (40%) had local recurrence and 4 (19%) metastatic disease. Mean disease-free interval before recurrence was 2.5 years (1-5). No patient (n = 8) treated in the past 9 years has had local or distant disease. Patients treated for recurrent tumor survived 5.7 years on average (range, 0.8-9) after the first recurrence. The only risk factor for tumor recurrence was proximal tumor extent (P = 0.05) There was a statistically significant association between recurrence and survival (RR = 3.8; 95% confidence interval, 1.0-15.3; P = 0.04). CONCLUSION.: Despite the complications, increased long-term survival can be achieved with treatment. Proximal tumor extent may be related to recurrence and survival. Recurrence rates have diminished over time, emphasizing the importance of an experienced multidisciplinary surgical team.Level of Evidence: N/A

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KW - complications

KW - en bloc resection

KW - oncological

KW - outcomes

KW - radiotherapy

KW - recurrence

KW - sacrum

KW - survival

KW - tumor

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