Introduction: Treatment strategies for spinal chordomas are heterogeneous and are mainly driven by institutional biases and local protocols. The aims of this international collaborative effort are to identify the main management options for newly diagnosed chordoma of the spine, understand the variations in treatment protocols among experienced centers, and to consequently design a multicenter prospective cohort study to help determine the best multimodal treatment for this patient population.
Methods: A survey was distributed to 39 spinal oncology specialists in neurosurgery, orthopaedic surgery, and radiation oncology from 29 centres. Two clinical scenarios were presented and the preferred management strategy was queried among the respondents: 1) a newly diagnosed chordoma of the spine when en bloc resection is feasible with acceptable morbidity, and 2) when en bloc resection is not feasible as it would result in significant morbidity. Based on the results of this survey, a prospective cohort study combining centers with similar treatment strategies for newly diagnosed chordoma of the spine is proposed.
Results: When en bloc resection is feasible with acceptable morbidity, most participants (79.5%) favored an en bloc resection without pre-operative neo-adjuvant radiation treatment (RT). The main disagreement is with the role of post-operative radiation with 41% giving RT only if positive margins and 38% giving adjuvant RT to everyone irrespective of marginal status. When en bloc resection would result in significant morbidity, results were more evenly distributed and 33% of respondents preferred to do a deliberate intralesional resection followed by RT, and 33% chose to give neo-adjuvant RT prior to surgery. These treatment options will constitute the distinct treatment cohorts of a prospective international cohort study.
Conclusions: The results of this survey allowed the design of an international collaborative prospective cohort study to uncover the best treatment strategy for patient with spinal chordomas.
Patient Care: The results of this study uncover the best treatment strategies for patient with spinal chordomas and will lead to a definitive answer to the most important question in spinal chordoma care.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Identify the management options for newly diagnosed chordoma of the spine
2) Understand the process that lead to an international collaborative prospective cohort study