Results following surgical resection of recurrent chordoma of the spine: experience in a single institution
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(2020) 18:228
RESEARCH
Open Access
Results following surgical resection of recurrent chordoma of the spine: experience in a single institution Pongsthorn Chanplakorn1* , Thamrong Lertudomphonwanit1, Wittawat Homcharoen1,2, Prakrit Suwanpramote1 and Wichien Laohacharoensombat1
Abstract Background: Chordoma 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 freemargin 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 methods: Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018 at one tertiary-care center was conducted. Results: There 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. Conclusion: En-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 marginfree resection to prevent further recurrence. Keywords: Chordoma, Recurrence, Surgical resection, Radiotherapy, Oncologic outcome
Introduction Chordomas are relatively rare, 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 therefore, 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 * Correspondence: [email protected] 1 Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok 10400, Thailand Full list of author information is available at the end of the article
survival but sometimes difficult to achieve this goal because of the complex surgical strategies and massive blood loss. Therefore, the rate or recurrent is high after the first surgery [2–5]. Local recurrence is the most important determinant of long-term survival, as Bergh et al. [4] reported a 21-fold increase in risk of tumor-related death in those with local recurrence, which greatly increased in an intralesional excision compared with en-bloc margin-free resection as confirmed in many studies [2–6]. However, wide en-bloc resection is not a
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