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J Neurosurg Spine. 2018 Oct 19;30(1):119-125. doi: 10.3171/2018.6.SPINE18362.

Current treatment strategy for newly diagnosed chordoma of the mobile spine and sacrum: results of an international survey.

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1Division of Spine Surgery, Vancouver General Hospital and The University of British Columbia, Vancouver, British Columbia, Canada.
2Oxford Spinal Unit, Oxford University Hospital, Oxford, United Kingdom.
3Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts.
4Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
5Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, and The Miriam Hospital, Providence, Rhode Island.
6Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
7Department of Radiation Oncology, University of Toronto and Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
8National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary.
9Centro Di Chirurgia Oncologia Ortopedica e Ricostruttiva del Rachide (CCOORR) and.
10GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
11Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy.
12Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
13Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada.
14Department of Orthopaedics, Peking University Third Hospital, HaiDian District, Beijing, China.
15Department of Neurosurgery, Institute of Cancer of the State of São Paulo, São Paulo, Brazil.
16Research Department, AOSpine International, Davos, Switzerland.
17Department of Orthopaedic Surgery, University of California, Los Angeles Medical Center, Los Angeles, California; and.
Departments of18Radiation Oncology and.
19Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.


OBJECTIVEThe purpose of this study was to investigate the spectrum of current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum.METHODSA survey on the treatment of spinal chordoma was distributed electronically to members of the AOSpine Knowledge Forum Tumor, including neurosurgeons, orthopedic surgeons, and radiation oncologists from North America, South America, Europe, Asia, and Australia. Survey participants were pre-identified clinicians from centers with expertise in the treatment of spinal tumors. The suvey responses were analyzed using descriptive statistics.RESULTSThirty-nine of 43 (91%) participants completed the survey. Most (80%) indicated that they favor en bloc resection without preoperative neoadjuvant radiation therapy (RT) when en bloc resection is feasible with acceptable morbidity. The main area of disagreement was with the role of postoperative RT, where 41% preferred giving RT only if positive margins were achieved and 38% preferred giving RT irrespective of margin status. When en bloc resection would result in significant morbidity, 33% preferred planned intralesional resection followed by RT, and 33% preferred giving neoadjuvant RT prior to surgery. In total, 8 treatment protocols were identified: 3 in which en bloc resection is feasible with acceptable morbidity and 5 in which en bloc resection would result in significant morbidity.CONCLUSIONSThe results confirm that there is treatment variability across centers worldwide for managing newly diagnosed chordoma of the mobile spine and sacrum. This information will be used to design an international prospective cohort study to determine the most appropriate treatment strategy for patients with spinal chordoma.


HRQOL = health-related quality of life; RT = radiation therapy; chordoma; mobile spine; oncology; radiation therapy; sacrum; treatment strategy

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