Cervical chordomas: multicenter case series and meta-analysis

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Akinduro, OO (Author) Other; Garcia, DP (Author) Other; Domingo, RA (Author) Other; Vivas Buitrago, T (Author) Other; Sousa Pinto, B (Author) FMUP; Bydon, M (Author) Other; Clarke, MJ (Author) Other; Gokaslan, ZL (Author) Other; Kalani, MA (Author) Other; Abode Iyamah, K (Author) Other; Quinones Hinojosa, A (Author) Other

Journal

Title: Journal of Neuro-Oncology

ISSN: 0167-594X

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 18 Citations

Scopus - 17 Citations

Other information

Authenticus ID: P-00T-RRB

DOI: 10.1007/s11060-021-03742-6

Abstract (EN): Background En bloc spondylectomy is the gold standard for surgical resection of sacral chordomas (CHO), but the effect of extent of resection on recurrence and survival in patients with CHO of the cervical spine remains elusive. Methods MEDLINE, Embase, Scopus, and Cochrane were systematically reviewed. Patients with cervical CHO treated at three tertiary-care academic institutions were reviewed for inclusion. We performed an individual participant data meta-analysis to assess the overall survival (OS) and progression free survival (PFS) after en bloc-gross total resection (GTR) and intralesional-GTR compared to subtotal resection (STR). We then performed an intention-to-treat analysis including all patients with attempted en bloc resection in the en bloc group, regardless of the surgical margins. Results There was a total of 13 series including 161 patients with cervical CHO, including our current series of 22 patients. GTR (en bloc-GTR + intralesional-GTR) was associated with a significant decrease in the risk of local progression (pooled hazard ratio (PHR) = 0.22; 95% CI 0.08-0.59; p = 0.003) and risk of death (PHR 0.31; 95%; CI 0.12-0.83; p = 0.020). A meta-regression analyses determined that intralesional-GTR improved PFS (PHR 0.35; 95% CI 0.16-0.76; p = 0.009) as well as OS (PHR 0.25; 95% CI 0.08-0.79; p = 0.019) when compared to STR. En bloc-GTR was associated with a significant reduction in the risk of local progression (PHR 0.06; 95% CI 0.01-0.77; p = 0.030), but not a decreased OS (PHR 0.50; 95% CI 0.19-1.27; p = 0.145). Our intention-to-treat analyses revealed a near significant improvement in OS for the en bloc group (PHR: 0.15; 95% CI 0.02-1.22; p = 0.054), and nearly identical improvement in PFS. Radiation data was not available for the studies included in the meta-analysis. Conclusion This is the first and only meta-analysis of patients with cervical CHO. We found that both en bloc-GTR and intralesional-GTR resulted in improved local tumor control when compared to STR.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 13