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Outcomes of Recurrent Mobile Spine Chordomas
Joshua M Kolz1, Elizabeth P Wellings, Matthew T Houdek
1From the Department of Orthopedic Surgery (Kolz, Wellings, Houdek, Yaszemski, and Rose), and the Department of Neurosurgery (Clarke), Mayo Clinic, Rochester, MN.
Introduction:
Chordomas of the mobile spine are rare malignant tumors. The purpose of this study was to review the outcomes of treatment for patients with recurrent mobile spine chordomas.
Methods:
The oncologic outcomes and survival of 30 patients undergoing treatment of a recurrent mobile spine chordoma were assessed over a 24-year period. The mean follow-up was 3.5 years.
Results:
In patients presenting with a recurrent mobile spine chordoma, the mean 2- and 5-year overall survival was 73% and 39%, respectively. Enneking appropriate resection trended toward improved overall survival at 5 years (100% vs. 32%, P = 0.24). Those undergoing surgical resection for recurrence had improved metastatic-free survival (hazard ratio 0.29, CI 0.08 to 0.99, P = 0.05). Positive margins were found to be a risk factor of further local recurrence (hazard ratio 7.92, CI 1.02 to 61.49, P = 0.04). Those undergoing nonsurgical management trended toward having an increase in new neurologic deficits (P = 0.09), however, there was no difference in overall complications based on treatment type (P = 0.13).
Conclusion:
Recurrent mobile spine chordoma portends a poor prognosis with an overall survival of less than 40% at 5 years. Surgical resection may help prevent new neurologic deficits and tumor metastasis while en bloc excision with negative surgical margins is associated with improved local recurrence-free survival.
Insights
Recurrent mobile spine chordomas have a poor prognosis, with less than 40% 5-year survival. Surgical resection may improve outcomes by preventing metastasis and neurologic deficits, with en bloc excision and negative margins reducing local recurrence.
Area of Science:
- Oncology
- Neurosurgery
- Orthopedic Oncology
Background:
- Chordomas are rare malignant tumors affecting the mobile spine.
- Recurrent cases present unique treatment challenges and prognostic considerations.
Purpose of the Study:
- To review treatment outcomes for patients with recurrent mobile spine chordomas.
- To assess oncologic outcomes and survival in this patient cohort.
Main Methods:
- Retrospective review of 30 patients with recurrent mobile spine chordoma over 24 years.
- Analysis of oncologic outcomes, survival rates, and complication data.
- Mean follow-up duration of 3.5 years.
Main Results:
- Mean 2- and 5-year overall survival rates were 73% and 39%, respectively.
- Surgical resection for recurrence improved metastatic-free survival (HR 0.29, P=0.05).
- Positive margins were a risk factor for local recurrence (HR 7.92, P=0.04); en bloc resection trended towards better 5-year survival (100% vs 32%).
Conclusions:
- Recurrent mobile spine chordoma indicates a poor prognosis, with survival below 40% at 5 years.
- Surgical resection may prevent new neurologic deficits and metastasis.
- En bloc excision with negative margins is linked to improved local recurrence-free survival.
