Retrospective Study Of Clinical Outcomes Of Chordoma

AbstractObjective: Owing to the special growth pattern of chordomas and the limited treatment options currently available,the treatment of chordoma still remains difficult.In this study,we hope to further clarify the relationship between surgical treatment and radiotherapy of chordoma and disease progression.Methods:All patients with a primary histopathological diagnosis of clival or spinal chordomas recorded in our institution between 1976 and 2017 were examined.Results:A total of 60 patients(location: skull base/clival,n = 24;vertebral column,n = 5;sacrum,n = 31)had a mean follow-up time of 7.7 years(range 12 months–35 years).Compared with patients who received subtotal resection(n = 5,5-year and 10-year survival = 61% and 39%,respectively),the annual survival rate of patients who received total resection(n = 55,5-year and 10-year survival = 67%,respectively)was significantly higher.The overall 10-year survival rate(58%)of patients treated with surgery alone was significantly different from those treated with a combination of surgery and radiation(73%).The long-term prognosis of sacral chordoma was the worst(10-year survival rate = 48%).Twenty-four patients(n = 24,40%)with chordoma had chordoma,including 14 males and 10 female patients(Table 2).The average age of onset is 37 years(range: 5-62 years).Symptoms included neurological deficits in 24 patients(100%),including multiple(>1)cranial nerve palsy in 5 patients,visual impairment in 10 patients,and CN VI palsy in 2 patients.Thirteen(n = 13,54%)patients developed headaches due to local tumor growth.The average time from symptom onset to clinical treatment was 8 months(range: 3 days to 12 months).Five patients(2 males,3 females)had lesions in the moving spine and 31 patients had tumor growth as the tibia.The number of male patients with sacral chordoma was higher than the number of female patients(male: n = 23,74%;female: n = 8,26%).The average age of onset in patients with spinal chordoma is 51 years(range: 21-72 years).Patients with sacral chordoma had the same mean age at age 51(range: 17-75 years;Table 2).Conclusions:The best treatment strategy for improved long-term survival in chordoma was a combination of surgical resection and radiation therapy.Adjuvant radiotherapy for chordoma significantly improves disease-free survival,although the long-term survival benefit remains to be determined.A worse prognosis and poor long-term survival are seen in sacral chordomas.