Clinical analysis of 21 patients with sacrococcygeal chordoma

Objective: To evaluate the clinical characteristics of sacrococcygeal chordoma and its treatment. Methods: The data from 21 patients (13 males and 8 females, with an average age of 58.8 years) with sacrococcygeal chordoma treated in our hospital from January 1989 to December 2004 were retrospectively reviewed. The mean diameter of the tumor was 9.5 cm, ranging from 4 to 25 cm. All of the patients underwent surgery. Three cases had radical surgery and 18 cases had partial excision. Eleven patients received surgery alone (S) and the other 10 patients were treated with surgery plus postoperative radiotherapy (S+R). The daily dose of radiotherapy was 180-200 cGy for five fractions a week and the total dose was 40-50 Gy delivered over 4-5 weeks. Results: In the follow-up period, 9 deaths occurred. Six cases died from local recurrence, 1 case died from bilateral lung metastasis and the other cases died from unrelated diseases. The overall 1-, 3-, 5- and 10-year survival rates were 100%, 95%, 85% and 41%, respectively. The 5-year survival rate was 81% in the S group and 89% in the S+R group, with no statistical significance between the 2 groups (P0.05). Local re- currence occurred in 15 cases (9 in the S group and 6 in the S+R group). The recurrence rate was 81.8% in the S group and 60% in the S+R group, with no significant difference (χ2=1.222, P0.05). The local recurrence time was 2-38 months after surgery in the S group and 23-72 months in the S+R group. The median recurrence time was 22 months in the S group and 48 months in the S+R group. Conclusion: Recurrence frequently occurred in patients with chordoma. Treatment methods affect recurrence. Radical resection is the most effi- cient treatment for sacrococcygeal chordoma. Postoperative radiotherapy does not remarkably increase survival or reduce the incidence of local recurrence, but it can delay the recurrence time.