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Chordoma of the Mobile Spine: A 15-Year Experience at the Massachusetts General Hospital
104S
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
CONCLUSIONS: This study provides new findings on the survival patterns of chordoma, with a significantly decreased risk of death seen with Hispanic race, high socioeconomic status, and surgical excision. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.273
225. Chordoma of the Mobile Spine: A 15-Year Experience at the Massachusetts General Hospital Andrew J. Schoenfeld, MD1, Francis X. Pedlow, MD2, Francis J. Hornicek, MD, PhD2, Joseph H. Schwab, MD, MS2; 1William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, TX, USA; 2Massachusetts General Hospital, Boston, MA, USA
BACKGROUND CONTEXT: Malignant primary osseous spinal neoplasms are aggressive tumors which remain associated with poor outcomes despite aggressive treatment. While surgical resection has been shown to improve short-term local control, it remains debated whether resection is associated with improved survival. PURPOSE: Evaluate the role of resection for patients with primary osseous spinal neoplasms. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: SEER registry. OUTCOME MEASURES: Survival. METHODS: The SEER registry (1973–2003) was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing’s sarcoma via ICD-O-2 coding. Extent of resection was defined by intra-operative surgeon assessment or radiographic analysis and classified as biopsy for tissue diagnosis, subtotal resection (STR), or gross-total resection (GTR). Differentiation between intra-lesional and enbloc resection was not made. Association of resection with overall survival was assessed via Cox proportional-hazards analysis adjusting for age, radiotherapy, and extent of local tumor invasion. RESULTS: 827 patients were identified with non-metastatic primary osseous spinal neoplasms (215 Chordoma, 282 Chondrosarcoma, 158 osteosarcoma, 172 Ewings Sracoma), Table 1. Tumors were more frequently located in the sacrum/pelvis vs. mobile spine for both surgically resected (74% vs. 26%) and biopsied lesions (88% vs. 12%). Surgical resection versus biopsy was associated with improved overall survival independent of age, radiotherapy, or extent of local tumor invasion for chordoma [HR, 0.34; p50.05], chondrosarcoma [HR, 0.14; p50.001], and osteosarcoma [HR, 0.42; p50.005], but not Ewings sarcoma [HR, 0.56; p50.10], Figure 1. GTR vs. STR was not associated with survival benefit for any tumor type. CONCLUSIONS: Surgical resection may play a role in prolonging survival in the multi-modality treatment of patients with primary spinal chordoma, chondrosarcoma, or osteosarcoma demonstrated prolonged overall survival. The value of surgical resection for Ewings sarcoma may be limited. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
BACKGROUND CONTEXT: Chordoma of the spine presents a difficult surgical challenge. Surgical excision is considered the standard of care, yet complete excision is not always possible. Several authors have identified recurrence, metastases and inadequate surgical margins as risk factors for decreased survival. PURPOSE: This study sought to describe the epidemiology, treatment and complications in a series of patients treated with surgery and/or radiation for spinal chordoma at our institution. We also sought to determine the effect of type of surgical resection, presence of local recurrence, and metastases on patient outcome. STUDY DESIGN/SETTING: Retrospective case series at a tertiary academic referral center. PATIENT SAMPLE: All cases of chordoma involving the spine located above the sacrum and below the clivus treated surgically at our institution between 1992 and 2007. OUTCOME MEASURES: Survivorship analysis was performed using Kaplan Meier methodology. Kaplan Meier methodology was also used to calculate disease specific survival and to compare survival between patients who had received en-bloc and intralesional resections. METHODS: We performed a retrospective review of cases of chordoma involving the spine located above the sacrum and below the clivus treated surgically at our institution between 1992 and 2007. Medical charts, radiology reports, pathology reports and operative notes were reviewed for all patients. Available imaging studies were also examined. Survivorship analysis was performed using Kaplan Meier methodology. Kaplan Meier methodology was also used to calculate disease specific survival and to compare survival between patients who had received en-bloc and intralesional resections. The effect of type of resection, surgical margins, presence of local recurrence, and metastasis on disease-specific survival were also investigated. Nonparametric and parametric variables were assessed with the use of the MannWhitney-U statistic, and analysis-of -variance, respectively. RESULTS: Twenty-six patients were treated surgically for spinal chordoma in the period under study. Twenty-four were also treated with radiation with a mean dose of 70 Gy (range 11–101.6). The median overall survival for all patients in this series was 98.7 months (SE 13.6, 95% CI 72–125). Nine patients were treated with an en-bloc resection and 8 of these had no evidence of disease at the time of last evaluation. Eleven of 17 patients treated with intralesional resections died from disease. Patients treated with en-bloc resection had an increased survival compared to those who underwent intralesional excision (p50.002). Similarly, en-bloc resection was associated with a decreased risk of local recurrence. (p50.02) Eight (31%) patients developed local recurrences and 3 (11.5%) developed metastasis. Local recurrence was associated with a trend toward decreased survival (p50.06). CONCLUSIONS: En-bloc resection was associated with improved overall survival and a reduced risk of local recurrence. There was a trend toward local recurrence having an adverse impact on survival. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.274
doi: 10.1016/j.spinee.2010.07.275
224. Association of Extent of Surgical Resection and Survival in Patients with Malignant Primary Osseous Spinal Neoplasms: A 30-Year Population-Based Study Debraj Mukherjee, MD1, Kaisorn Chaichana, MD1, Scott L. Parker, MD1, Ziya Gokaslan, MD1, Joseph Cheng, MD2, Matthew McGirt, MD2; 1Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Vanderbilt University, Nashville, TN, USA
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
CONCLUSIONS: This study provides new findings on the survival patterns of chordoma, with a significantly decreased risk of death seen with Hispanic race, high socioeconomic status, and surgical excision. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.273
225. Chordoma of the Mobile Spine: A 15-Year Experience at the Massachusetts General Hospital Andrew J. Schoenfeld, MD1, Francis X. Pedlow, MD2, Francis J. Hornicek, MD, PhD2, Joseph H. Schwab, MD, MS2; 1William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, TX, USA; 2Massachusetts General Hospital, Boston, MA, USA
BACKGROUND CONTEXT: Malignant primary osseous spinal neoplasms are aggressive tumors which remain associated with poor outcomes despite aggressive treatment. While surgical resection has been shown to improve short-term local control, it remains debated whether resection is associated with improved survival. PURPOSE: Evaluate the role of resection for patients with primary osseous spinal neoplasms. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: SEER registry. OUTCOME MEASURES: Survival. METHODS: The SEER registry (1973–2003) was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing’s sarcoma via ICD-O-2 coding. Extent of resection was defined by intra-operative surgeon assessment or radiographic analysis and classified as biopsy for tissue diagnosis, subtotal resection (STR), or gross-total resection (GTR). Differentiation between intra-lesional and enbloc resection was not made. Association of resection with overall survival was assessed via Cox proportional-hazards analysis adjusting for age, radiotherapy, and extent of local tumor invasion. RESULTS: 827 patients were identified with non-metastatic primary osseous spinal neoplasms (215 Chordoma, 282 Chondrosarcoma, 158 osteosarcoma, 172 Ewings Sracoma), Table 1. Tumors were more frequently located in the sacrum/pelvis vs. mobile spine for both surgically resected (74% vs. 26%) and biopsied lesions (88% vs. 12%). Surgical resection versus biopsy was associated with improved overall survival independent of age, radiotherapy, or extent of local tumor invasion for chordoma [HR, 0.34; p50.05], chondrosarcoma [HR, 0.14; p50.001], and osteosarcoma [HR, 0.42; p50.005], but not Ewings sarcoma [HR, 0.56; p50.10], Figure 1. GTR vs. STR was not associated with survival benefit for any tumor type. CONCLUSIONS: Surgical resection may play a role in prolonging survival in the multi-modality treatment of patients with primary spinal chordoma, chondrosarcoma, or osteosarcoma demonstrated prolonged overall survival. The value of surgical resection for Ewings sarcoma may be limited. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
BACKGROUND CONTEXT: Chordoma of the spine presents a difficult surgical challenge. Surgical excision is considered the standard of care, yet complete excision is not always possible. Several authors have identified recurrence, metastases and inadequate surgical margins as risk factors for decreased survival. PURPOSE: This study sought to describe the epidemiology, treatment and complications in a series of patients treated with surgery and/or radiation for spinal chordoma at our institution. We also sought to determine the effect of type of surgical resection, presence of local recurrence, and metastases on patient outcome. STUDY DESIGN/SETTING: Retrospective case series at a tertiary academic referral center. PATIENT SAMPLE: All cases of chordoma involving the spine located above the sacrum and below the clivus treated surgically at our institution between 1992 and 2007. OUTCOME MEASURES: Survivorship analysis was performed using Kaplan Meier methodology. Kaplan Meier methodology was also used to calculate disease specific survival and to compare survival between patients who had received en-bloc and intralesional resections. METHODS: We performed a retrospective review of cases of chordoma involving the spine located above the sacrum and below the clivus treated surgically at our institution between 1992 and 2007. Medical charts, radiology reports, pathology reports and operative notes were reviewed for all patients. Available imaging studies were also examined. Survivorship analysis was performed using Kaplan Meier methodology. Kaplan Meier methodology was also used to calculate disease specific survival and to compare survival between patients who had received en-bloc and intralesional resections. The effect of type of resection, surgical margins, presence of local recurrence, and metastasis on disease-specific survival were also investigated. Nonparametric and parametric variables were assessed with the use of the MannWhitney-U statistic, and analysis-of -variance, respectively. RESULTS: Twenty-six patients were treated surgically for spinal chordoma in the period under study. Twenty-four were also treated with radiation with a mean dose of 70 Gy (range 11–101.6). The median overall survival for all patients in this series was 98.7 months (SE 13.6, 95% CI 72–125). Nine patients were treated with an en-bloc resection and 8 of these had no evidence of disease at the time of last evaluation. Eleven of 17 patients treated with intralesional resections died from disease. Patients treated with en-bloc resection had an increased survival compared to those who underwent intralesional excision (p50.002). Similarly, en-bloc resection was associated with a decreased risk of local recurrence. (p50.02) Eight (31%) patients developed local recurrences and 3 (11.5%) developed metastasis. Local recurrence was associated with a trend toward decreased survival (p50.06). CONCLUSIONS: En-bloc resection was associated with improved overall survival and a reduced risk of local recurrence. There was a trend toward local recurrence having an adverse impact on survival. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.274
doi: 10.1016/j.spinee.2010.07.275
224. Association of Extent of Surgical Resection and Survival in Patients with Malignant Primary Osseous Spinal Neoplasms: A 30-Year Population-Based Study Debraj Mukherjee, MD1, Kaisorn Chaichana, MD1, Scott L. Parker, MD1, Ziya Gokaslan, MD1, Joseph Cheng, MD2, Matthew McGirt, MD2; 1Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Vanderbilt University, Nashville, TN, USA
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.