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Updated: Dec 21, 2025
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
The sacral chordoma margin
S Radaelli1, P Fossati2, S Stacchiotti3
1Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Objective:
Aim of the manuscript is to discuss how to improve margins in sacral chordoma.
Background:
Chordoma is a rare neoplasm, arising in half cases from the sacrum, with reported local failure in >50% after surgery.
Methods:
A multidisciplinary meeting of the "Chordoma Global Consensus Group" was held in Milan in 2017, focusing on challenges in defining and achieving optimal margins in chordoma with respect to surgery, definitive particle radiation therapy (RT) and medical therapies. This review aims to report on the outcome of the consensus meeting and to provide a summary of the most recent evidence in this field. Possible new ways forward, including on-going international clinical studies, are discussed.
Results:
En-bloc tumor-sacrum resection is the cornerstone of treatment of primary sacral chordoma, aiming to achieve negative microscopic margins. Radical definitive particle therapy seems to offer a similar outcome compared to surgery, although confirmation in comparative trials is lacking; besides there is still a certain degree of technical variability across institutions, corresponding to different fields of treatment and different tumor coverage. To address some of these questions, a prospective, randomized international study comparing surgery versus definitive high-dose RT is ongoing. Available data do not support the routine use of any medical therapy as (neo)adjuvant/cytoreductive treatment.
Conclusion:
Given the significant influence of margins status on local control in patients with primary localized sacral chordoma, the clear definition of adequate margins and a standard local approach across institutions for both surgery and particle RT is vital for improving the management of these patients.
Insights
Improving surgical and radiation therapy margins is crucial for sacral chordoma patients. Achieving negative margins through en-bloc resection or particle radiation therapy improves local control for this rare bone tumor.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Chordoma is a rare bone neoplasm, frequently originating in the sacrum.
- Over 50% of sacral chordoma cases experience local recurrence after surgical treatment.
Purpose of the Study:
- To discuss strategies for optimizing surgical and radiation therapy margins in sacral chordoma.
- To report outcomes from the Chordoma Global Consensus Group meeting.
- To summarize recent evidence and future directions in sacral chordoma management.
Main Methods:
- Multidisciplinary consensus meeting focused on surgical, particle radiation therapy (RT), and medical therapies for chordoma.
- Review of current evidence and ongoing international clinical studies.
- Discussion of challenges in defining and achieving optimal margins.
Main Results:
- En-bloc tumor-sacrum resection is the primary surgical approach for sacral chordoma, aiming for negative margins.
- Radical particle RT shows comparable outcomes to surgery, but comparative trial data is limited.
- No current medical therapies are recommended for routine adjuvant or cytoreductive use.
Conclusions:
- Achieving negative margins is critical for local control in sacral chordoma.
- Standardized approaches to surgical resection and particle RT are vital for improving patient outcomes.
- Ongoing research, including comparative trials, is essential for refining treatment strategies.
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