Evaluating the Role of Adjuvant Radiotherapy in Management of Sacral and Vertebral Chordoma: Results from a National Database

Abstract Introduction Chordomas are slow-growing but locally invasive tumors. Standard of care consists of surgical resection and radiotherapy when complete resection is not possible. Current literature has reached equivocal results with regards to the effect of adding radiotherapy on patient survival. Herein, we investigated the effect of adjuvant radiotherapy on patient survival. Methods The National Cancer Database was queried for patients diagnosed with sacral and vertebral column chordoma between 2004-2010. The primary outcome was Overall Survival(OS) which was assessed using Kaplan-Meier plots. Cox proportional hazards were performed to evaluate the effect of each treatment modality on survival after adjusting for an array of patient demographics, facility type and tumor characteristics. Results A total of 282 chordoma patients were analyzed. 209patients(74.1%) were treated with GTR alone. Median follow-up periods for the two groups were 63.4 and 67.6 months, respectively. Mean survival was comparable between patients receiving GTR alone and adjuvant RT, both in sacral(7.7 and 6.9 years(p=0.56)) and vertebral chordoma (8.8 and 6.2 years(p=0.59)). Using Cox proportional-hazards, we found that compared to GTR alone, GTR with adjuvant radiotherapy did not add any significant survival benefit, either in sacral chordoma(HR:0.55, p=0.43), or in vertebral chordoma patients (HR:7.29,p=0.23). Conclusion Based on data from a large national cancer registry, we found that there isn’t enough evidence to suggest that additional radiotherapy offers survival benefit in patients with sacral and spinal chordoma after gross total resection. Given the non-negligible complications associated with radiotherapy, balance of benefits and risks must be taken into consideration during preoperative tailoring of decision making.