Sakral Kordomalarda Tedavi Yaklaşımları

Yıl 2006, Cilt: 39 Sayı: 2, 104 - 107, 01.08.2006

Şafak Güngör Yaman Karakoç Deniz Gürler Burak Atalay Ataç Karakaş Murat Arıkan

Öz

Sacral chordomas are relatively rare, locally invasive, maiignant neoplasms. Chordomas is characterized by a high failure rate and a poor fonctional outcome. Six patients were treated for sacral chordoma between 2000-2006 in our clinic. Due to inadequate response to chemo and radiotheraphy, sacrococcygeal chordoma which is a primary malign bone tumour should be excised completely as an optimal therapeutic modality. Complete surgical exploration depends on site of affected tissues and tumour localisation. To prevent these postoperative complications such as pelvic instability, urinary-feacal incontinence, incomplet excision may be a treatment option vvith high local reccurence rate. We advocate an attempt at complete resection and aggressive treatment of local reccurence.

Anahtar Kelimeler

Chordoma, sacrococygeal.

The Treatment Modalities in Sacral Chordomas

Öz

Sakral kordomalar nispeten nadir görülen, lokal invaziv, malign tümörlerdir. Yüksek başarısızlık oranı ve kötü fonksiyonel geri dönüşle karakterizedirler. Kliniğimizde 2000-2006 yılları arasında takip edilen altı sakral kordoma olgusu sunulmuştur. Primer malign bir kemik tümörü olan sakrokoksigeal kordomaların radyoterapi ve kemoterapiye yetersiz yanıtı nedeniyle optimal tedavi olarak komplet eksizyon gereklidir. Kordomaların komplet çıkarılması için uygun cerrahi sınır, tutulan dokulara ve tümörün lokalızasyonuna göre değişmektedir. Tümörün derin dokulara invazyonu sonucu peivik instabilite ve üriner-fekal inkontinans gibi komplikasyonlardan korunmak amacıyla lokal rekürrens ile sonuçlanan inkomplet eksizyon yapılmaktaysa da, biz tedavide komplet rezeksiyon ve lokal rekürrens halinde ise agresif müdahaleyi savunuyoruz.

Anahtar Kelimeler

Kordoma, sakrokoksigeal.

Kaynakça

• Özdemir M. Sacrococsygeal chordoma: A case report. İzmir Atatürk Eğitim Hastanesi Tıp Dergisi 2005:43.
• Fuchs B, Dickey I, Yaszemski M, inwards C, Sim F. Operative management of sacral chordoma. The Journal of Bone&Joint Surgery 2005;87-A:2211-6.
• Baratti D, Gronchi A, Pennacchioli E, et al. Chordoma: Natural history and results in 28 patients treated at a single institution. Ann Surg Oncol 2003;10:291-6.
• Şar C. Total sacrectomy and lumbopelvic reconstruction for primary tumors of the sacrum. Açta Orthop Traumatol Turc 2001;35:79-83.
• Yonemoto T, Tatezaki S, Takenouchi T, Ishii T, Satoh T, Moriya H. The surgical management o f sacrococcygeai chordoma. Cancer 1999;85:878-83.
• Darly R, Fourney MD, Gokasian Z. Current management of sacral chordoma. Neurosurg Focus 2003; 15.
• Anson KM, Byrne PO, Robertson İD, et al. Radical excision of sacrococcygeai tumours. Br J Surg 1994;81:460-1.
• Smith J, Ludwig RL, Marcove RC. Sacrococcygeai chordo­ ma. A clinicoradiological study of 60 patients. Skeletal Radiol 1987;16:37-44.
• Greenspan A. Tumors and Tumor-Like Lesions. Part 4. 3rd ed. Philadelphia: Lippincott VVİlliams&VVUkins, 2000:701-3.
• Stephens GC, Schwartz HS. Lumbosacral chordoma resec- tion: Image integration and surgical planning. J Surg Oncol 1993;54:226-32.
• Dahlin DC, McCarty LS. Chordoma: A study of 59 cases. Cancer 1952;5:1170-8.
• Gökasian ZL, Romsdahl MM, Kroll SS, et al. Total sacrecto­ my and Galveston L-rod reconstruction for malignant neo- plasms. Technical note. J Neurosurg 1997;87:781-7.
• Tomita K, Tsuchiya H. Total sacrectomy and reconstruction forhuge sacral tumors. Spine 1990;15:1223-7.
• Gunterberg B, Kewenter J, Petersen I, Stener B. Anorectal function after majör resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg 1976;63:546-54.
• Gunterberg B, Romanus B, Stener B. Pelvic strength after majör amputation of the sacrum. An experimental study. Açta Orthop Scand 1976;47:635-42.
• Ishii K, Chiba K, Watanabe M, Yabe H, Fujimura Y, Toy ama Y. Local reccurence after S2-3 sacrectomy in sacral chor­ doma. Report of four cases. J Neurosurg 2002;97:98-101.