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

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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.


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.


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.


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.

ABBREVIATIONS HRQOL = health-related quality of life; RT = radiation therapy.

Article Information

Correspondence Nicolas Dea: Vancouver General Hospital and The University of British Columbia, Vancouver, BC, Canada.

INCLUDE WHEN CITING Published online October 19, 2018; DOI: 10.3171/2018.6.SPINE18362.

Disclosures Dr. Dea reports consultant relationships with Medtronic, Baxter, 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 following 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.

© AANS, except where prohibited by US copyright law.



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    Results for the first question: What is your preferred treatment strategy for a newly diagnosed chordoma of the spine when en bloc resection is feasible with acceptable morbidity?

  • View in gallery

    Results for the second question: What is your preferred treatment strategy for newly diagnosed chordoma of the spine when en bloc resection would result in significant morbidity (upper cervical, high sacrectomy)?

  • View in gallery

    Proposed treatment pathways for a prospective cohort study.



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