Role of intraoperative radiotherapy in the treatment of sacral chordoma

Publication date: Available online 4 September 2017
Source:The Spine Journal
Author(s): A.C. Jullien-Petrelli, J.M. Asencio, M.I. Orue-Echebarria, P. Lozano, A. Álvarez, J. Serrano, F.M. Calvo, J.A. Calvo-Haro, J.M. Lasso, J.L. García-Sabrido
Background contextSacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. Till date, there are not any series available in literature combining surgery and intraoperative radiotherapy (IORT).PurposeTo report the experience of our Centre in the management of sacral chordoma combining radical resection with both external radiotherapy and intraoperative radiotherapy (IORT).Study DesignRetrospective case series.Patients sample15 patients with sacral chordoma resected in our centre from 1998 to 2015.Outcome measuresOverall survival (OS), Disease free survival and rates of local and distant recurrence.MethodsWe retrospectively revised the records of all the patients with sacral chordoma resected in our centre from 1998 to December 2015. Overall survival (OS), Disease free survival and rates of local and distant recurrence were calculated. Results between patients treated with or without IORT were compared.ResultsA total of 15 patients were identified: 8 males and 7 females. Median age was 59 years (range 28-77). IORT was applied in 9 patients and 6 were treated with surgical resection without IORT. In 13 patients we performed the treatment of the primary tumor and in 2 patients we performed the treatment of recurrence disease. A posterior approach was used in 4 patients. Wide surgical margins (R0) were achieved in 6 patients, marginal margins (R1) in 7 patients and there were not any patient with intralesional (R2) margins. At a median follow up of 38 months (range 11-209 months), the 5 years OS in the IORT group was 100% versus 53% in the group of non-IORT (p=0.05). The median DFS in the IORT group was 85 months versus 41 months in the non-IORT group. In the group without IORT, two patients died and nobody died during the follow up in the group treated with IORT. High sacrectomy treated patients had a median survival of 41 months versus 90 months in low sacrectomy treated patients. DFS in patients without gluteal involvement was 100% at 5 years, and 40% in patients with gluteal involvement (fig 8). All patients with a recurrence in our study had gluteal involvement.ConclusionsMultidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in overall survival and disease-free survival. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed in order to confirm the utility of IORT.



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