Chordoma in Orthopedic Surgery Treatment & Management

Updated: Dec 05, 2022
  • Author: Nagarjun Rao, MD, FRCPath; Chief Editor: Jeffrey A Goldstein, MD  more...
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Approach Considerations

Treatment options include the following:

  • Low-dose [25] or high-voltage radiation therapy
  • Combined radiation and surgery
  • Surgical excision alone [26]

It has been generally accepted that complete surgical excision of the tumor is the only curative procedure. Because of local invasion, many tumors (especially skull-base chordomas) may not be amenable to complete surgical excision, and the local recurrence rate is high. [27, 28, 29, 30, 31, 32]  Sterotactic radiosurgery (SRS) may be effective for some chordomas. [33]


Surgical Care

Tumors detected and diagnosed early have a favorable prognosis if treated with a complete or en-bloc excision. [34]  A complete excision may involve a combined anterior-posterior operation, with anterior vertebrectomy, strut grafting, and possible stabilization with instrumentation. This is followed by a posterior decompression that also removes the pedicles and by stabilization of the spine with instrumentation above and below the excised levels.

Extension of the tumor beyond the confines of the vertebral body decreases the chances of a complete cure. Resection of the psoas muscle and sacrifice of lumbar or sacral nerve roots may be necessary. Preservation of both S3 nerve roots is required if normal bladder and bowel function are to be expected postoperatively. In these cases, surgical margin decisions are made on an individual basis. If complete resection of the tumor cannot be carried out and residual tumor is present either in bone or soft tissue, postoperative megavoltage radiation therapy is indicated.

The local recurrence rate is affected by tumor contamination of the surgical wound. [35]  In one study, the recurrence rate was 64% when contamination was present and 28% when no contamination was present. [36]

A systematic review by Bin-Alamer et al assessed SRS with or without postoperative fractionated radiation therapy in adults with skull-base chordomas. [33]  Tumor control and survival rates for SRS alone were not found to be inferior to those for SRS plus fractionated radiation therapy.

The endoscopic endonasal approach is ain increasingly popular option for for clival chordomas. [37]