Management of spinal chordomas and sarcomas: WFNS spine committee recommendations

Objective

This retrospective review aims to provide the most up-to-date information on the management of chordomas and sarcomas of the spine.

Material and methods

We performed separate literature searches on chordomas and spinal sarcomas from the last ten years (2014–2024), excluding non-English literature, case reports, and irrelevant papers. Using the Delphi method and two rounds of voting at international meetings, ten members of the World Federation of Neurosurgical Societies (WFNS) Spine Committee developed nine consensus statements.

Results and discussion

Management of chordomas is complex due to high recurrence rates, with an average life expectancy of six years. Total sacrectomy is viable for sacral chordomas at S2 and below. The preferred management strategy remains surgical resection followed by radiation therapy, as chordomas exhibit high resistance to chemotherapy. Conversely, en bloc resection with wide margins is the gold standard for chondrosarcomas, while radiation therapy is recommended after piecemeal resection. Chondrosarcomas and osteosarcomas are primarily treated with surgical resection, whereas Ewing sarcoma requires a multimodal approach that includes neoadjuvant chemotherapy, surgery, and radiation therapy.

Conclusions

Management of spinal chordomas and sarcomas features distinct challenges. Chordomas, particularly in the sacrum, often recur. Sacrectomy is effective for sacral chordomas at S2 and below. Surgical resection is crucial for chondrosarcomas, which are unresponsive to chemotherapy. In contrast, radical surgery is often required for osteosarcoma and Ewing’s sarcoma following neoadjuvant therapy.