Role of intraoperative radiotherapy in the treatment of sacral chordoma.

Sacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. To date, there are no series available in literature combining surgery and intraoperative radiotherapy (IORT). The objective of this study was to report the experience of our center in the management of sacral chordoma combining radical resection with both external radiotherapy and IORT. This is a retrospective case series. The patient sample included 15 patients with sacral chordoma resected in our center from 1998 to 2015. The outcome measures were overall survival (OS), disease-free survival (DFS), and rates of local and distant recurrences. We retrospectively reviewed the records of all the patients with sacral chordoma resected in our center from 1998 to December 2015. Overall survival, DFS, and rates of local and distant recurrences were calculated. Results between patients treated with or without IORT were compared. A total of 15 patients were identified: 8 men and 7 women. The median age was 59 years (range 28-77). Intraoperative radiotherapy was applied in nine patients and six were treated with surgical resection without IORT. In 13 patients, we performed the treatment of the primary tumor, and in two patients, we performed the treatment of recurrence disease. A posterior approach was used in four patients. Wide surgical margins (zero residue) were achieved in six patients, marginal margins (microscopic residue) were achieved in seven patients, and there were no patients with intralesional (R2) margins. At a median follow-up of 38 months (range 11-209 months), the 5-year OS in the IORT group was 100% versus 53% in the group of non-IORT (p=.05). The median DFS in the IORT group was 85 months, and that in the non-IORT group was 41 months. In the group without IORT, two patients died and nobody died during the follow-up in the group treated with IORT. High-sacrectomy treated patients had a median survival of 41 months, and low-sacrectomy treated patients had a median survival of 90 months. Disease-free survival in patients without gluteal involvement was 100% at 5 years, and that in patients with gluteal involvement was 40%. All patients with a recurrence in our study had gluteal involvement. Multidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in OS and DFS. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed to confirm the utility of IORT.

Jullien-Petrelli AC ，García-Sabrido JL ，Orue-Echebarria MI ，Lozano P ，Álvarez A ，Serrano J ，Calvo FM ，Calvo-Haro JA ，Lasso JM ，Asencio JM ... -  《-》

Surgical Treatment of Sacral Chordoma: En Bloc Resection with Negative Margins is a Determinant of the Long-Term Outcome.

Colangeli S ，Muratori F ，Bettini L ，Frenos F ，Totti F ，D'Arienzo A ，Campo FR ，Scoccianti G ，Beltrami G ，Campanacci DA ，Capanna R ... -  《-》

Sacral Chordoma: Long-term Outcome of a Large Series of Patients Surgically Treated at Two Reference Centers.

Radaelli S ，Stacchiotti S ，Ruggieri P ，Donati D ，Casali PG ，Palmerini E ，Collini P ，Gambarotti M ，Porcu L ，Boriani S ，Gronchi A ，Picci P ... -  《-》

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

Ji T ，Guo W ，Yang R ，Tang X ，Wang Y ，Huang L ... -  《-》

Oncologic and functional outcome following sacrectomy for sacral chordoma.

Hulen CA ，Temple HT ，Fox WP ，Sama AA ，Green BA ，Eismont FJ ... -  《-》