title: Sacrectomy and adjuvant radiotherapy for the treatment of sacral chordomas: a single-center experience over 27 years.
abstract: METHODS
  Retrospective cohort (case only).
  
  
  OBJECTIVE
  To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy.
  
  
  BACKGROUND
  There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood.
  
  
  METHODS
  Demographics, treatment, complications, and oncological outcomes were analyzed with summary statistics, hypothesis testing with Mantel-Haenszel-Cox analysis, log-rank test, Cox proportional hazard model, and Kaplan-Meier survival estimates as applicable.
  
  
  RESULTS
  There were 12 males and 9 females with mean age of 61 years (16-79) and mean follow-up of 5.8 years (2-19.2). Tumor stage was IB in 20 and IIIB in one; mean tumor size was 10.5 cm. Fourteen patients underwent combined anterior-posterior resection and 7 posterior resection alone; 18 received adjuvant radiotherapy. After treatment, bowel and bladder control were present in 4 and 5 patients, respectively. Complications included: wound infection (4), other wound complications (9), fistula (2), deep vein thrombosis (1), and pulmonary embolism (1). Median survival was 7.2 years. Eight (40%) had local recurrence and 4 (19%) metastatic disease. Mean disease-free interval before recurrence was 2.5 years (1-5). No patient (n = 8) treated in the past 9 years has had local or distant disease. Patients treated for recurrent tumor survived 5.7 years on average (range, 0.8-9) after the first recurrence. The only risk factor for tumor recurrence was proximal tumor extent (P = 0.05) There was a statistically significant association between recurrence and survival (RR = 3.8; 95% confidence interval, 1.0-15.3; P = 0.04).
  
  
  CONCLUSIONS
  Despite the complications, increased long-term survival can be achieved with treatment. Proximal tumor extent may be related to recurrence and survival. Recurrence rates have diminished over time, emphasizing the importance of an experienced multidisciplinary surgical team.
  
  
  METHODS
  N/A.
authors.affiliation: *Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL †Department of Epidemiology, University of Delaware, Newark, DE; and ‡Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Arjun A
authors.initials: AA
authors.lastname: Dhawale
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Gjolaj
authors.forename: Laurens
authors.initials: L
authors.lastname: Holmes
authors.forename: Laurence R
authors.initials: LR
authors.lastname: Sands
authors.forename: H Thomas
authors.initials: HT
authors.lastname: Temple
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Eismont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002817:Chordoma / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005402:Fistula / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012447:Sacrum / Q000528:radiation effects / Q000601:surgery*; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology; D014946:Wound Infection / Q000209:etiology; D055815:Young Adult