Recurrence patterns after resection of sacral chordoma: toward an optimized postoperative target volume definition
Background: Postoperative recurrence of sacrococcygeal chordomas presents significant clinical challenges due to unusual recurrence patterns. This study aimed to characterize these patterns of recurrence to inform improved adjuvant radiotherapy planning. Methods: We retrospectively analyzed 31 patie...
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| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
30 July 2025
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| In: |
Cancers
Year: 2025, Volume: 17, Issue: 15, Pages: 1-13 |
| ISSN: | 2072-6694 |
| DOI: | 10.3390/cancers17152521 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3390/cancers17152521 Verlag, kostenfrei, Volltext: https://www.mdpi.com/2072-6694/17/15/2521 
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| Author Notes: | Hanna Waldsperger, Burkhard Lehner, Andreas Geisbuesch, Felix Jotzo, Eva Meixner, Laila König, Sebastian Regnery, Katharina Kozyra, Lars Wessel, Sandro Krieg, Klaus Herfarth, Jürgen Debus and Katharina Seidensaal |
| Summary: | Background: Postoperative recurrence of sacrococcygeal chordomas presents significant clinical challenges due to unusual recurrence patterns. This study aimed to characterize these patterns of recurrence to inform improved adjuvant radiotherapy planning. Methods: We retrospectively analyzed 31 patients with recurrent sacrococcygeal chordoma following surgery, assessing recurrence locations considering initial tumor extent, resection levels, and postoperative anatomical changes on MRI. In 18 patients, pre- and postoperative imaging enabled the spatial mapping of early recurrence origins relative to the initial tumor volume using isotropic expansions. The median initial gross tumor volume was 113 mL. Results: Recurrences were mostly multifocal and predominantly involved soft tissues (e.g., mesorectal/perirectal space (80.6%), piriformis and gluteal muscles (80.6% and 67.7%, respectively) and osseous structures, particularly the sacrum (87.1%)). The median time to recurrence was 15 months. The initial surgery was R0 in 17 patients (55%). The highest infiltrated sacral vertebra was S1 in 3%, S2 in 10%, S3 in 35%, S4 in 23%, S5 in 10%, and coccygeal in 19%. Anatomical changes post-resection, including rectal herniation into gluteal and subcutaneous tissues, significantly affected radiotherapy planning. Expansion of the initial tumor volume by 2 cm failed to encompass all recurrence origins in 72% of cases. A 5 cm expansion was required to achieve full coverage in 56% of patients, though 22% of recurrences still lay beyond this margin and the remaining were covered only partially. Conclusions: Recurrent sacrococcygeal chordomas exhibit complex, soft-tissue-dominant patterns and are influenced by significant anatomical displacement post-surgery. Standard target volume expansions are often insufficient to cover the predominantly multifocal recurrences. |
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| Item Description: | Veröffentlicht: 30. Juli 2025 Gesehen am 15.01.2026 |
| Physical Description: | Online Resource |
| ISSN: | 2072-6694 |
| DOI: | 10.3390/cancers17152521 |