Association of radical vs palliative resection of spinal chordoma with survival: a population-based study

Excerpt

Chordoma is a rare notochordal tumor of the skull base, spine and sacrum which poses a treatment challenge due to its malignant behavior and relative insensitivity to traditional radio- and chemo-therapeutic treatment options [1]. Extent of surgical resection is known to be the primary determinant of oncologic outcomes in patients with chordoma of the mobile spine and sacrum, with wide or en bloc resection being the preferred treatment [2‐5]. The tendency for chordoma to arise in the midline and invest itself within critical adjacent neurovascular anatomy, however, can make en bloc resection technically challenging, and at times relatively morbid for patients. In cases where en bloc resection would be impossible due to patient-related medical factors or would result in neurological deficits unacceptable to the patient, subtotal, intra-lesional, or otherwise “palliative” resection may be considered. While oncologic outcomes after palliative resections for spinal chordoma have been shown to be inferior to those afforded by en bloc resection in general, the goal of this study was to examine to what degree patient- and/or tumor-specific factors influence this disparity, and whether certain patients are able to achieve oncologic outcomes after palliative resection similar to those seen with radical resection. …