• Archives of Plastic Surgery
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• 제37권5호
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• pp.702-704
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• 2010

Purpose: Chordoma is a rare primary osseous tumor arising from the remnants of the primitive notochord. It occurs once in 2,000,000. It is characterized by its slow growth, high frequency to invade destroy bone by direct extension. We experienced giant sacral chordoma and reconstructed with gluteal advancement flap. Methods: A 52-year-old woman presented with a 2-years history of gluteal pain. In the biopsy study revealed sacral chordoma. MRI study showed $13{\times}12{\times}10\;cm$ sized m0cs. We approached anterior and posterior resection and reconstructed with bilateral gluteus maximus advancement flap. Results: After the operation, blader and anal function were slightly decreased. But, 4 months later those were almost fully recovered. There was no significant complication and recurrence after 2-years follow-up. Conclusion: Chordoma is characterized by its slow growth, high frequency to invade and destroy bone by direct extension. Wide surgical resection is the only curative procedure. We report a ase of giant sacral chordoma which was successfully treated by anterior and posterior approach and reconstructed with bilateral gluteal advancement flap.

• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.523-527
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• 2011

A 67-year-old woman presented for evaluation of severe coccygeal pain. The computed tomography scans and magnetic resonance imaging showed an asymmetric midline sacral tumor invading the right lower portion of S2. To preserve both S2 nerve roots and to obtain negative surgical margins, a modified mid-sacrectomy with an aid of a computed navigation system was performed. The sacral tumor was excised en bloc with negative tumor margins. Both S2 nerve roots were preserved and additional reconstruction was not necessary because of minimal resection of the sacroiliac joint. We report a case of a sacral chordoma which was excised en bloc with adequate surgical margins by a computer-assisted modified mid-sacrectomy. The computed navigation system may be a useful tool for tumor targeting and safe osteotomies in sacral tumor surgery via the posterior only approach.

• 대한골관절종양학회지
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• 제11권2호
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• pp.148-154
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• 2005

목적: 천추에 발생한 척색종에 대해 수술적 치료를 시행했던 환자들의 장기 추시 결과를 알아보고자 하였다. 대상 및 방법: 천추 척색종으로 수술을 시행받았던 4예를 대상으로 하였으며, 평균 추시 기간은 8.3년(3~11)이었다. 3예에서 후방 도달법을, 1예에서는 전후방 도달법을 통해 종양의 완전 절제를 시행하였으며, 1예에서 제 2천추 신경근 이상을, 3예에서 제 3천추 신경근 이상을 보존하였다. 술 후 배뇨, 배변 장애 유무를 포함한 하지의 운동, 감각 장애 유무를 평가하였고 수술 부위 감염 등의 합병증과 추시상 국소적인 재발 및 원거리 전이 유무를 조사하였다. 결과: 전 예에서 술 후 하지의 운동 장애는 없었으나 1예에서 우하지의 방사통이 심하였고, 1예에서 수술창의 감염이 있었다. 술 후 배뇨 기능은 2예에서 정상이었고 1예에서는 간헐적 요실금을, 1예에서는 지속적인 자가 도뇨를 시행하였다. 배변 기능은 1예에서 정상이었고, 2예에서는 변비를 보였다. 추시상 1예에서 재발 및 전이가 없었고, 1예에서 수술 부위의 재발이, 1예에서 원거리 전이 및 수술 부위의 재발이 있었다. 결론: 천추에 발생한 척색종에 대하여 수술적 절제 후 평균 8년 이상의 생존으로 만족할 만한 결과를 보였으며, 조기 발견을 통한 적극적인 수술적 치료가 상부 천추 신경근의 보존으로 기능 소실의 최소화와 함께 생존을 연장할 수 있는 방법으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.35-38
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• 2009

We present a patient with multifocal symptomatic osseous chordomas having unusual growth patterns with review of the pertinent literature. The patient was 62-year-old male and had multiple osseous chordomas located in sacral, thoracic, and paraclival jugular foramen areas. There was no metastasis in other organs. All affected sites were osseous. The multicentric chordomas are extremely rare. This case could be considered as a chordoma involving multiple neuraxial bones. But, the possibility of multicentricity could also be thought. In such cases radical resection should be performed for each lesion at the initial diagnosis. If complete surgical resections are infeasible or impossible, preoperative or postoperative radiation therapy should be planned for the highest possibility of successful treatment.

• 대한골관절종양학회지
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• 제18권2호
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• pp.66-71
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• 2012

목적: 천골에 발생한 척색종의 치료결과 분석을 통해 생존율 및 종양의 국소조절과 연관된 예후인자에 대하여 알아보고자 하였다. 대상 및 방법: 1990년 1월부터 2010년 2월까지 본원에서 치료받은 19예를 대상으로 하였다. 평균연령은 56세였으며 남자9예, 여자 10예였다. 15명의 환자에서 후방접근법을 이용한 절제술을 시행하였으며 4명의 환자는 방사선 치료만을 시행하였다. 종양의 위치가 S3 보다 근위부를 침범한 경우가 6예였으며 이중 4예에서 방사선 치료만을 시행하였다. 광범위 절제 6예, 변연부 절제 8예, 병소내 절제 1예였다. 평균 추시 기간은 63개월(25-144개월)이었다. 결과: 5년 무병 생존율 및 전체 생존율은 각각 34.7%, 79.7%였다. 재발은 9예, 원격전이는 7예에서 발생하였다. 생존율에 관계된 예후 인자는 종양의 제3천추 상방 침범유무(p=0.033), 종양의 크기(p=0.032)였다. 수술 후 합병증으로 배뇨 및 배변 장애가 발생한 경우가 9예였으며 이중 2예에서는 자가도뇨 시행이 필요하거나 중증의 요실금이 발생하였다. 결론: 종양의 절제 가능성 여부와 더불어 전반적인 환자상태와 수술 후 발생 가능한 합병증을 고려한 치료방법의 선택이 생존율과 함께 삶의 질을 높일 수 있는 방법으로 생각된다.

• Radiation Oncology Journal
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• 제36권3호
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• pp.182-191
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• 2018

Purpose: To investigate the clinical outcome of proton therapy (PT) in patients with chordoma. Materials and Methods: Fifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and disease-specific survival (DSS) rates were calculated by the Kaplan-Meier method. Results: With the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4. Conclusion: PT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.