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Cervical chordomas: multicenter case series and meta-analysis.

Oluwaseun O Akinduro1, Diogo P Garcia1, Ricardo A Domingo1

  • 1Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.

Journal of Neuro-Oncology
|April 3, 2021
PubMed
Summary

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Complete resection of cervical chordomas (CHO) improves outcomes. Both en bloc-gross total resection (GTR) and intralesional-GTR offer better local tumor control and survival compared to subtotal resection (STR) for cervical chordomas.

Area of Science:

  • Neurosurgery
  • Orthopedic Oncology
  • Spine Surgery

Background:

  • Cervical chordomas (CHO) are rare bone tumors.
  • En bloc spondylectomy is standard for sacral chordomas, but its impact on cervical CHO is unclear.
  • The extent of surgical resection's effect on recurrence and survival in cervical CHO requires investigation.

Purpose of the Study:

  • To evaluate the impact of surgical resection extent on outcomes in cervical chordoma (CHO).
  • To compare overall survival (OS) and progression-free survival (PFS) after different resection strategies for cervical CHO.
  • To determine the efficacy of en bloc-gross total resection (GTR) versus intralesional-GTR and subtotal resection (STR).

Main Methods:

  • Systematic review of MEDLINE, Embase, Scopus, and Cochrane databases.
Keywords:
Cervical spineChordomaEn bloc spondylectomyGross total resectionSubtotal resection

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  • Individual participant data meta-analysis of 161 patients with cervical CHO from 13 series.
  • Comparison of outcomes for en bloc-GTR, intralesional-GTR, and STR, including an intention-to-treat analysis.

    • Main Results:

    • Gross total resection (GTR), encompassing both en bloc-GTR and intralesional-GTR, significantly reduced the risk of local progression and death.
    • Intralesional-GTR improved PFS and OS compared to STR.
    • En bloc-GTR significantly reduced local progression risk, with a trend towards improved OS.

    Conclusions:

    • This meta-analysis is the first to investigate surgical resection extent in cervical chordoma (CHO).
    • Both en bloc-GTR and intralesional-GTR lead to superior local tumor control compared to STR.
    • Achieving GTR is crucial for improving outcomes in patients with cervical chordoma.