Sacral chordoma outcome
Chordoma in the sacrum is an aggressive, locally invasive neoplasm, and has a poor prognosis.
The presence of subcutaneous fat extension was an independent predictor of decreased OS. Other MRI findings with potential for future evaluation include size, presence of soft tissue tail, extension above L5/S1, and sacroiliac joint and piriformis muscle invasion 1).
A study identified two predictive variables for local recurrence-free survival (LRFS) (previous tumor surgery and type of surgical resection) and two for overall survival (OS) (age and impaired motor function) in surgically treated SC patients. The results indicate that en bloc resection reduces LR but does not influence OS. However, this was likely due to short follow-up (3.2 years) 2).
Dedifferentiated chordomas are aggressive malignant tumors with a higher risk of local recurrence, metastases, and early mortality than conventional chordomas. Tumor diameter >10 cm, marginal resection, and sacroiliac joint infiltration may be associated with increased risk of local recurrence and mortality. Those with a smaller burden of dedifferentiated disease (<1 cm) within the primary chordoma have a better prognosis. Patients should be counseled about these risks before surgery and should have regular follow-up for the detection of local recurrence and metastases 3).