TY - JOUR
T1 - Current treatment strategy for newly diagnosed chordoma of the mobile spine and sacrum
T2 - Results of an international survey
AU - AOSpine Knowledge Forum Tumor
AU - Dea, Nicolas
AU - Fisher, Charles G.
AU - Reynolds, Jeremy J.
AU - Schwab, Joseph H.
AU - Rhines, Laurence D.
AU - Gokaslan, Ziya L.
AU - Bettegowda, Chetan
AU - Sahgal, Arjun
AU - Lazáry, Áron
AU - Luzzati, Alessandro
AU - Boriani, Stefano
AU - Gasbarrini, Alessandro
AU - Laufer, Ilya
AU - Charest-Morin, Raphaële
AU - Wei, Feng
AU - Teixeira, William
AU - Germscheid, Niccole M.
AU - Hornicek, Francis J.
AU - DeLaney, Thomas F.
AU - Shin, John H.
N1 - Funding Information:
This study was organized by AOSpine International, through the AOSpine Knowledge Forum Tumor, a pathology-focused working group of international spine experts acting on behalf of AOSpine in the domain of scientific expertise. We are especially grateful to the individuals who responded to the survey.
Funding Information:
and Stryker and direct stock ownership in Medtronic. Dr. Fisher reports consultant relationships with Medtronic and NuVasive as well as receipt of royalties from Medtronic. Dr. Rhines reports an educational relationship with Stryker. Dr. Gokaslan reports direct stock ownership in Spinal Kinetics. Dr. Sahgal reports the follow- ing financial relationships: educational seminars with Elekta AB, Accuray Inc, and Varian Medical Systems; a research grant from Elekta AB; and travel accommodations/expenses from Elekta and Varian. Dr. Sahgal also reports belonging to the Elekta MR Linac Research Consortium. Dr. Laufer reports consultant relationships with Globus, Medtronic, DePuy/Synthes, Spinewave, and Brainlab. Ms. Germscheid reports an employee relationship with AOSpine International.
Publisher Copyright:
©AANS 2019.
PY - 2019/1
Y1 - 2019/1
N2 - OBJECTIVE The purpose of this study was to investigate the spectrum of current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum. METHODS A 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. RESULTS Thirty-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. CONCLUSIONS The 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.
AB - OBJECTIVE The purpose of this study was to investigate the spectrum of current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum. METHODS A 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. RESULTS Thirty-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. CONCLUSIONS The 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.
KW - Chordoma
KW - Mobile spine
KW - Oncology
KW - Radiation therapy
KW - Sacrum
KW - Treatment strategy
UR - http://www.scopus.com/inward/record.url?scp=85064136379&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064136379&partnerID=8YFLogxK
U2 - 10.3171/2018.6.SPINE18362
DO - 10.3171/2018.6.SPINE18362
M3 - Article
C2 - 30497218
AN - SCOPUS:85064136379
SN - 1547-5654
VL - 30
SP - 119
EP - 125
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 1
ER -