Abstract
INTRODUCTION: Results on surgical treatment of chordomas from series published in the literature are disappointing with survival rate of 50% and 35% respectively at five and 10 years. In most reports, surgical resection is limited to a palliative decompression or at best to a subtotal resection. The purpose of this study is to evaluate the results of patients treated aggressively by several surgeries and radiotherapy from 1989 to 2000.
METHODS: From a series of 36 patients presenting with cervical (N=8) or suboccipital (N=28) chordomas, 22 were referred primarily while 14 were sent to us for a recurrence after a previous partial surgical resection. In both groups of patients, we proposed as radical a surgical resection as possible realised in one to four surgical stages followed by radiotherapy (and protontherapy for the more recent cases).
RESULTS: Patients seen at first presentation (group A) underwent 1,9 surgeries in average and 10 of them could have a protontherapy while in group B patients referred after recurrence, 1,4 surgeries were carried out and three could have a protontherapy. Follow-up extends from one to 11 years (mean 4 years).
Actuarial survival rate was 80 and 65% respectively at five and 10 years in group A as compared to 50 and 0% in group B. Actuarial recurrence free rate was 70 and 35% at five and 10 years in group A and 0% at three years in group B. Disease related mortality was 15% in group A and 63% in group B. The rate of recurrence per year was 0,15 in group A and 0,62 in group B. The mean delay before the first recurrence was 43 months in group A and 15 months in group B.
Factors such as sex, age, duration of symptoms, severity of symptoms, extent of tumour, histological type or grading have no influence on the survival rate and the recurrence free rate. Even the comparison between patients having received or not radiotherapy and patients treated or not by protontherapy failed to show any difference. However these groups of patients are very small and include group A and group B patients.
CONCLUSION: Aggressive surgical treatment at first presentation of patients with chordomas seems to provide better results in terms of survival and recurrence. However it requires several surgical stages (up to four) followed by radio and protontherapy. No other factors have proven to influence the prognosis. In case of patients already presenting a recurrence this aggressiveness does not seem to be justified. Therefore after this study, aggressive surgical treatment was only proposed to primary patients (N=12) and not on patients with recurrence (N=7).
These abstracts were prepared by Dr Robert J. Moore. Correspondence should be addressed to him at Spine Society of Australia, Institute of Medical and Veterinary Science, The Adelaide Centre for Spinal Research, Frome Road, Adelaide, South Australia 5000.
