Our experience with chordoma treatment

Abstract

PURPOSE OF THE STUDY: The aim of the study was to evaluate the group of patients operated on for chordoma at our department. We present diagnostic and surgical management options relevant to the localisation of chordoma in the spine, and evaluate the results in terms of post-operative complications, tumour recurrence and patient survival. MATERIAL AND METHODS: Between 1989 and 2002 a total of 20 patients diagnosed with chordoma were treated. There were 15 men and five women with an average age of 53 years. The cervical spine was affected in 20 %, thoracic in 15%, lumbar in 25% and sacral in 40 % of the patients. All of them suffered from back pain, and nine patients (45 %) had neurological symptoms. The average time from the onset of complaints till disease diagnosis was 7.2 months. RESULTS: The average survival time was 63 months, with eight patients (40 %) surviving for more than five years. Of the patients with chordoma of the mobile spine, 66 % were treated by a combined antero-posterior procedure involving somatectomy, vertebral body replacement and posterior stabilisation; for sacral spine chordoma, a dorsal approach was always used. Of 11 patients (55 %) who required repeat surgery, eight had recurrent tumour and three had wound infection. DISCUSSION Chordomas are rare, slow-growing tumours usually diagnosed with a delay, particularly when localised in the sacral spine. At present magnetic resonance imaging is the essential diagnostic method allowing us to plan the appropriate surgical management. When the mobile spine is affected, a combined antero-posterior procedure including somatectomy, vertebral body replacement with a graft or implant and posterior stabilisation is used. When the sacral spine is involved, some authors prefer en bloc resection from the posterior approach, others use a combined antero-posterior procedure. Chordomas are known to have a high risk of local recurrence. Post-operative radiotherapy, which makes the disease-free interval longer, is recommendedúúú chemotherapy has no effect. CONCLUSIONS: Chordomas are associated with serious diagnostic and therapeutic problems, with frequent local recurrence. Prognosis is good if early diagnosis is made, and en bloc resection is performed.