title: Epidemiologic, functional, and oncologic outcome analysis of spinal sarcomas treated surgically at a single institution over 10 years.
abstract: BACKGROUND
  Spinal sarcomas are aggressive tumors that originate from the cells of mesechymal origin, specifically fat, cartilage, bone, and muscle. They are high-grade lesions, and treatment of spinal sarcomas can involve chemotherapy, radiation therapy, and surgery. In the appendicular skeleton, sarcomas are often treated with amputation, however, in the spinal column, surgical resection poses a unique set of challenges.
  
  
  OBJECTIVE
  To better understand the optimal treatment regimens and the impact of en bloc or intralesional resection on patient outcome.
  
  
  METHODS
  A cohort of 25 sarcoma patients treated at a single medical institution between 2002 and 2012 was reviewed.
  Patients were classified by tumor type for subgroup analysis, including chondrosarcoma, osteosarcoma, and other malignant spinal sarcomas. Demographic data for review included patient age, tumor type, tumor location, surgery type, exposure to chemotherapy, and radiation therapy.
  
  
  METHODS
  Survival statistics and Kaplan-Meier curves were calculated using GraphPad Prism 5.0. The threshold for statistical significance was set at p<.05. Unpaired, two-tailed, equal variance t tests were performed for statistical analyses in Microsoft Excel 2010.
  
  
  RESULTS
  Twenty-five patients with spinal sarcomas were treated over the 10-year period. Diagnosis included chondrosarcoma (n=9), osteosarcoma (n=4), and other sarcomas (n=12). Mean age at the time of diagnosis was 42 years. Pain was present at the time of diagnosis in 92% patients. Median survival after surgery was 59.5 months for chondrosarcoma, undefined for other sarcomas, and 16.8 months for osteosarcoma. Median survival after en bloc resection was undefined. Median survival after intralesional resection was 17.8 months. The difference in median survival between en bloc and intralesional resection was statistically significant (p=.049).
  
  
  CONCLUSIONS
  The authors report the largest cohort of patients with spinal sarcoma. Median survival in this cohort was the longest for patients with sarcomas of varying pathologies. Median survival was longer for chondrosarcoma. En bloc resection demonstrated a survival advantage over intralesional resection. Long-term follow-up is needed for patients with spinal sarcoma to establish definitive survival data.
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Mari L
authors.initials: ML
authors.lastname: Groves
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Zadnik
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kaloostian
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Jackson
authors.initials: J
authors.lastname: Sui
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: The Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 5-185, Baltimore, MD 21205, USA. Electronic address: dsciubba@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012737:Sex Factors; D013125:Spinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chondrosarcoma; En bloc; Osteosarcoma; Outcome; Sarcoma; Spine; Surgery; Tumor