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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.
The Journal of the American Academy of Orthopaedic Surgeons
|February 2, 2023
Summary
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.
