Therapeutic strategies for mobile spine chordoma: en bloc Versus intralesional surgery with adjuvant charged-particle therapy

Mario De Robertis; Riccardo Ghermandi; Valerio Pipola; Cristiana Griffoni; Marco Cianchetti; Marco Rotondi; Emanuela Asunis; Giovanni Tosini; Chiara Cini; Emanuela Morenghi; Luigi Emanuele Noli; Chiara Alcherigi; Annalisa Monetta; Giuseppe Tedesco; Silvia Terzi; Marco Girolami; Giovanni Barbanti Bròdano; Maria Rosaria Fiore; Stefano Bandiera; Alessandro Gasbarrini

doi:10.1007/s11060-024-04841-w

Therapeutic strategies for mobile spine chordoma: en bloc Versus intralesional surgery with adjuvant charged-particle therapy

J Neurooncol. 2024 Oct 17. doi: 10.1007/s11060-024-04841-w. Online ahead of print.

Authors

Mario De Robertis^#^{1

2}, Riccardo Ghermandi^#³, Valerio Pipola³, Cristiana Griffoni⁴, Marco Cianchetti⁵, Marco Rotondi⁶, Emanuela Asunis³, Giovanni Tosini³, Chiara Cini³, Emanuela Morenghi⁷, Luigi Emanuele Noli^{3

8}, Chiara Alcherigi³, Annalisa Monetta³, Giuseppe Tedesco³, Silvia Terzi³, Marco Girolami³, Giovanni Barbanti Bròdano³, Maria Rosaria Fiore⁶, Stefano Bandiera³, Alessandro Gasbarrini^{3

9}

Affiliations

¹ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072, Italy.
² Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089, Italy.
³ Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli, 1, Bologna, 40136, Italy.
⁴ Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli, 1, Bologna, 40136, Italy. cristiana.griffoni@ior.it.
⁵ Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
⁶ Radiation Oncology Unit, Clinical Department, CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy.
⁷ Biostatistics Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, 20089, Italy.
⁸ ISNB Istituto delle Scienze Neurologiche di Bologna, Via Altura,3, Bologna, 40139, Italy.
⁹ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

^# Contributed equally.

PMID: 39417983
DOI: 10.1007/s11060-024-04841-w

Abstract

Purpose: The aim of this retrospective study is to analyze the impact of en bloc resection with negative margins versus intralesional resection plus adjuvant hadron-therapy (HT) on local control (LC) and overall survival (OS) in patients with mobile spine chordomas. Mechanical complications incidence as well as risk factors, and outcome differences are investigated as secondary endpoints.

Methods: 33 patients in a period from January 2013 to December 2021 were enrolled for the final analysis. The inclusion criteria were: lesions located in the mobile spine (C1-L5), age ≥ 15 years, minimum follow-up of 2 years, en bloc or intralesional surgical resection, virgin or recurrent chordomas, with only one previous surgical treatment.

Results: No difference was found in terms of LC between the two groups. The presence of pathologic fracture at pre-operative imaging and the presence of macroscopic residual tumor after surgery, independently from its entity, seemed to be associated with an increased risk of LR. No difference was found between planned en bloc and planned intralesional surgery in terms of mechanical complications occurrence. Eight patients (24.24%) had mechanical complications during the follow up period: male sex, presence of pathologic fracture at baseline, a combined surgical approach, the use of carbon fiber-only hardware appeared to be associated with an increased risk of mechanical complications after the primary surgery.

Conclusions: En bloc resection, whenever possible, is always to be preferred for its widely recognized potential in LC and OS improvement. However, technology advances in high-dose conformal charged-particle therapy have allowed improvement of local control rates as an adjuvant therapy of intralesional surgery for mobile spine chordoma, with acceptable acute and chronic toxicity.

Keywords: Carbon Ion Radiotherapy (CIRT); Chordoma (Ch); En Bloc Spondylectomy (EBS); Gross total resections (GTRs); Hadron Therapy (HT); Primary bone tumors (PBT); Proton Beam Radiotherapy (PBT); Spine (S); Subtotal resections (STRs).