Portal de Periódicos da CAPES

The sacral chordoma margin

2020; Elsevier BV; Volume: 46; Issue: 8 Linguagem: Inglês

10.1016/j.ejso.2020.04.028

1532-2157

Stefano Radaelli, P Fossati, Silvia Stacchiotti, T. Akiyama, José Manuel Asencio, Stefano Bandiera, Antonella Boglione, Patrick J. Boland, Stéphanie Bolle, Øyvind S. Bruland, Antonella Brunello, Paolo Bruzzi, Domenico Andrea Campanacci, Ferdinando Cananzi, Rodolfo Capanna, R. Casadei, A. Córdoba, Charles Court, Angelo Paolo Dei Tos, Thomas F. DeLaney, Antonino De Paoli, Tommaso Martino De Pas, Atman Desai, Lucia Di Brina, Davide María Donati, Nicola Fabbri, Maria Rosaria Fiore, Anna Maria Frezza, Marco Gambarotti, Antonio Gasbarrini, Petra Georg, Giovanni Grignani, Nadia Hindi, Eugen B. Hug, Robin L. Jones, Akira Kawai, Augustinus D. G. Krol, Franel le Grange, Alessandro Luzzati, Gloria Marquina, Juan Antonio Martín-Benlloch, Ketti Mazzocco, Federico Navarria, Pierina Navarria, Paolo Domenico Parchi, Shreyaskumar Patel, Elisabetta Pennacchioli, Maria Grazia Petrongari, Piero Picci, Rob Pollock, Luca Porcu, Vittorio Quagliuolo, Claudia Sangalli, S. Scheipl, Gennaro Scotto, Mateusz Spałek, Theresa Steinmeier, Beate Timmermann, Annalisa Trama, Matthias Uhl, Claudia Valverde, Péter Varga, R. Vergés, Damien C. Weber, Carmine Zoccali, Paolo G. Casali, J. Sommer, Alessandro Gronchi,

Oral and Maxillofacial Pathology

Abstract Objective Aim of the manuscript is to discuss how to improve margins in sacral chordoma. Background Chordoma is a rare neoplasm, arising in half cases from the sacrum, with reported local failure in >50% after surgery. Methods A multidisciplinary meeting of the "Chordoma Global Consensus Group" was held in Milan in 2017, focusing on challenges in defining and achieving optimal margins in chordoma with respect to surgery, definitive particle radiation therapy (RT) and medical therapies. This review aims to report on the outcome of the consensus meeting and to provide a summary of the most recent evidence in this field. Possible new ways forward, including on-going international clinical studies, are discussed. Results En-bloc tumor-sacrum resection is the cornerstone of treatment of primary sacral chordoma, aiming to achieve negative microscopic margins. Radical definitive particle therapy seems to offer a similar outcome compared to surgery, although confirmation in comparative trials is lacking; besides there is still a certain degree of technical variability across institutions, corresponding to different fields of treatment and different tumor coverage. To address some of these questions, a prospective, randomized international study comparing surgery versus definitive high-dose RT is ongoing. Available data do not support the routine use of any medical therapy as (neo)adjuvant/cytoreductive treatment. Conclusion Given the significant influence of margins status on local control in patients with primary localized sacral chordoma, the clear definition of adequate margins and a standard local approach across institutions for both surgery and particle RT is vital for improving the management of these patients.