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Cho, Lee, Jeon, Song, Kong, Lee, and Cho: Oncologic Outcome of Sacral Chordoma
Original Article
The Journal of the Korean Bone and Joint Tumor Society

The Journal of the Korean Bone and Joint Tumor Society 2012; 18(2): 66-71.

Published online: 21 December 2012

DOI: https://doi.org/10.5292/jkbjts.2012.18.2.66

Oncologic Outcome of Sacral Chordoma

Sang-Hyun Cho*, Soo Yong Lee, Dae-Geun Jeon, Won-Seok Song, Chang-Bae Kong, Jung-Dong Lee, Wan-Hyeong Cho

Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.

*Department of Orthopedic Surgery, Dongnam Institution of Radiological & Medial Sciences, Busan, Korea.

Correspondence to: Wan-Hyeong Cho. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. TEL: +82-2-970-1243, FAX: +82-2-970-2403, chowanda@naver.com

Received 23 October 2012       Revised 16 November 2012       Accepted 20 November 2012

Copyright © 2012 by The Korean Bone and Joint Tumor Society

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

We analyzed treatment result to examine the outcome for patients with sacral chordoma and to determine relevant prognostic factors.

Materials and Methods

We retrospectively reviewed 19 patients with sacral chordoma seen at out institution between 1990 and 2010. There were 9 men and 10 women with mean age of 56 years. The average follow up was 63 months (range, 25-144 months). 15 patient received surgical treatment, six of these patient had wide, eight had marginal, one had intralesional margin and 4 patient treated with Radiation therapy only.

Results

The disease free and overall survival rate for all 19 patients was 34.7% and 79.7% at 5-years, respectively. Statistical analysis using the log-rank test revealed no significant difference between the surgery and radiation therapy groups in overall survival (p=0.54). Nine of 19 patients had local recurrence at a median of 2.5 years postoperatively. Seven of these 9 patients had distant metastasis at a median of 4.5 years postoperatively. Among the variables, tumor size (p=0.033) and tumor involvement of above S3 (p=0.032) were independent prognostic factor for overall survival. Nine of 15 patients who received surgical treatment had postoperative complication such as voiding difficulty and incontinence.

Conclusion

Careful consideration of the patient general condition and predictable complication of the treatment might be the best way to improve patient's survival and quality of life.

Keywords: sacrum, chordoma, prognostic factor

Figures and Tables

Figure 1
(A) Overall survival of the entire series of 19 chordoma patients. (B) Disease free survival of the entire series of 19 chordoma patients.
jkbjts-18-66-g001
Figure 2
Overall survival by prognostic factors, the differences were significant. (A) Tumor location: below S3 or above S3 (p=0.033). (B) Tumor volume: more than 200 cm3 or less than 200 cm3 (p=0.032).
jkbjts-18-66-g002
Table 1
Demographic and Clinoco-pathologic Data
jkbjts-18-66-i001

AWD, alive with disease; CDF, continuous disease free; DOD, dead of disease; PF, progression free; NA, not available; RT, radiation therapy.

Table 2
Comparison of Published Results
jkbjts-18-66-i002

References

1. Hanna SA, Aston WJ, Briggs TW, Cannon SR, Saifuddin A. Sacral chordoma: can local recurrence after sacrectomy be predicted? Clin Orthop Relat Res. 2008. 466:2217–2223.
2. McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001. 12:1–11.
3. Ferraresi V, Nuzzo C, Zoccali C, et al. Chordoma: clinical characteristics, management and prognosis of a case series of 25 patients. BMC Cancer. 2010. 10:22.
4. Nishida Y, Kamada T, Imai R, et al. Clinical outcome of sacral chordoma with carbon ion radiotherapy compared with surgery. Int J Radiat Oncol Biol Phys. 2011. 79:110–116.
5. Mirra JM, Della Rocca C, Nelson SD, Mertens F. Fletcher CD, Unni K, Mertens F, editors. Chordoma. Pathology and genetics of tumours of soft tissue and bone. 2002. Lyon, France: IARC Press;316–317.
6. Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012. 13:e69–e76.
7. Catton C, O'Sullivan B, Bell R, et al. Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol. 1996. 41:67–72.
8. York JE, Kaczaraj A, Abi-Said D, et al. Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery. 1999. 44:74–79.
9. Samson IR, Springfield DS, Suit HD, Mankin HJ. Operative treatment of sacrococcygeal chordoma. A review of twenty-one cases. J Bone Joint Surg Am. 1993. 75:1476–1484.
10. Wuisman P, Lieshout O, Sugihara S, van Dijk M. Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthop Relat Res. 2000. (381):192–203.
11. Baratti D, Gronchi A, Pennacchioli E, et al. Chordoma: natural history and results in 28 patients treated at a single institution. Ann Surg Oncol. 2003. 10:291–296.
12. Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, Eismont FJ. Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am. 2006. 88:1532–1539.
13. Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Joint Surg Am. 2005. 87:2211–2216.
14. Kaiser TE, Pritchard DJ, Unni KK. Clinicopathologic study of sacrococcygeal chordoma. Cancer. 1984. 53:2574–2578.
15. Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 2000. 88:2122–2134.
16. Gunterberg B, Norlén L, Stener B, Sundin T. Neurourologic evaluation after resection of the sacrum. Invest Urol. 1975. 13:183–188.
17. Gunterberg B, Kewenter J, Petersén I, Stener B. Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg. 1976. 63:546–554.
18. Zabel-du Bois A, Nikoghosyan A, Schwahofer A, et al. Intensity modulated radiotherapy in the management of sacral chordoma in primary versus recurrent disease. Radiother Oncol. 2010. 97:408–412.
19. Cheng EY, Ozerdemoglu RA, Transfeldt EE, Thompson RC Jr. Lumbosacral chordoma. Prognostic factors and treatment. Spine (Phila Pa 1976). 1999. 24:1639–1645.
20. Stacchiotti S, Casali PG, Lo Vullo S, et al. Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers. Ann Surg Oncol. 2010. 17:211–219.
21. Stener B, Gunterberg B. High amputation of the sacrum for extirpation of tumors Principles and technique. Spine (Phila Pa 1976). 1978. 3:351–366.
22. Yonemoto T, Tatezaki S, Takenouchi T, Ishii T, Satoh T, Moriya H. The surgical management of sacrococcygeal chordoma. Cancer. 1999. 85:878–883.
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