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Recurrent Upper Cervical Chordomas After Radiotherapy: Surgical Outcomes and Surgical Approach Selection Based on Complications

Wang, Yu MD; Xu, Wei MD; Yang, Xinghai MD; Jiao, Jian MD; Zhang, Dan MD; Han, Shuai MD; Xiao, Jianru MD

doi: 10.1097/BRS.0b013e31829c2bb0
Cervical Spine

Study Design. Retrospective review of a case series.

Objective. To present and analyze our surgical results of recurrent chordomas in the upper cervical spine after radiotherapy and compare 2 surgical strategies.

Summary of Background Data. Surgical treatment of recurrent chordomas in the upper cervical spine after radiotherapy is clinically rare but extremely challenging. No reports are found in the literatures focusing on the surgical results and strategies of such recurrent chordomas.

Methods. Clinical data of 8 patients with recurrent chordomas in the upper cervical spine after radiotherapy were retrospectively reviewed.

Results. Preoperative symptoms were relieved after our surgical procedures in 7 of the 8 patients. Total tumor removal was achieved in 6 of the 8 patients. Surgical complications mainly including cerebrospinal fluid leak and incision disunion were observed in 6 of the 8, and all the 3 patients after transoral operation had those complicated surgical complications, whereas the other 3 of the 5 patients after anterior retropharyngeal operation had relatively slighter complications. The disease free survival rates 1 year and 2 years after the surgery in this series were 50% and 12.5%, respectively, comparing with the general survival rates 1 year and 2 years after the surgery 87.5% and 37.5%.

Conclusion. Revised surgery is effective for improving quality of life of patients with recurrent upper cervical chordomas after radiotherapy before further tumor recurrence. However, the prognosis of those patients is usually poor and surgical complications mainly including incision disunion and cerebrospinal fluid leak are common. To reduce the risk of surgical complications, anterior retropharyngeal approach may be superior to the transoral approach.

Level of Evidence: N/A

A series of 8 patients with recurrent upper cervical chordomas after radiotherapy were reviewed. The prognosis of those patients is usually poor and surgical complications are common. To reduce the risk of surgical complications, anterior retropharyngeal approach may be superior to the transoral approach.

From the Spinal Tumor Center, Changzheng Hospital, Second Military Medical University, Shanghai, China.

Address correspondence and reprint requests to Jianru Xiao, MD, 415 Fengyang Road, Shanghai 200003, China; E-mail: jianruxiao83@163.com

Acknowledgment date: February 22, 2013. First revision date: April 7, 2013. Second revision date: April 24, 2013. Acceptance date: May 11, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins