Sacral chordoma: can local recurrence after sacrectomy be predicted?
S A Hanna1, W J S Aston, T W R Briggs
1Department of Orthopaedic Oncology, Sarcoma Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. sammyhanna@hotmail.com
Clinical Orthopaedics and Related Research
|June 28, 2008
Summary
Sacral chordoma recurrence is high (66%). Tumor invasion of adjacent muscles (piriformis, gluteus maximus) and sacroiliac joint involvement at diagnosis predict local recurrence after sacrectomy.
Area of Science:
- Oncology
- Surgical Pathology
- Orthopedic Oncology
Background:
- Sacral chordomas are rare bone tumors.
- Surgical resection margins are critical for outcomes in sacral chordoma.
- Local recurrence rates remain a significant challenge.
Purpose of the Study:
- To investigate the prognostic significance of posterior pelvic musculature invasion at initial diagnosis.
- To determine the relationship between tumor invasion and local recurrence after sacrectomy for sacral chordoma.
Main Methods:
- Retrospective review of 18 patients with sacral chordoma (1998-2005).
- Analysis of histologically verified tumors and surgical outcomes.
- Correlation of local recurrence with initial tumor invasion and surgical margins.
Main Results:
- Local recurrence occurred in 66% of patients.
- Tumor invasion of adjacent muscles (piriformis, gluteus maximus) was present in 14 patients, with 85% experiencing local recurrence.
- Sacroiliac joint involvement was associated with a 90% local recurrence rate.
Conclusions:
- Posterior pelvic musculature invasion and sacroiliac joint involvement are significant predictors of local recurrence.
- Achieving wide posterior surgical margins, including resection of these structures, may improve local disease control.
- Further research into optimizing surgical strategies for sacral chordoma is warranted.
