Cryosurgical treatment of sacrococcygeal chordoma. Report of four cases.

Sacrococcygeal chordoma is a rare malignant neoplasm situated in a location adjacent to important structures. Distant metastases are usually rare and occur late. The treatment of choice usually consists of radical surgery, sometimes followed by radiotherapy. Extensive surgical resection is difficult and often causes bladder and/or bowel dysfunction, and the local recurrence rate remains high. In an attempt to diminish both risks, the authors introduced cryosurgery in situ as a new treatment modality for chordoma in the sacrococcygeal region. From 1974 to 1980, four patients (two male, two female) with sacrococcygeal chordoma were treated with cryosurgery without resection. Two patients had extensive tumors (greater than 10 cm) and could be treated only palliatively. Two other patients with smaller tumors (less than 10 cm) had radical cryosurgical treatment. Both patients are disease-free 10 and 7 years after cryosurgical treatment. One of the palliatively treated patients is alive with local recurrence 4 years after cryosurgery, the other died of tumor after 5 years. In a cryosurgical lesion, the tissue is completely devitalized; however, the architecture of the tissue in peripheral nerves, large vessels, and bone is preserved and remains as a perfect autograft. Frozen tissue is very susceptible to the hematogenous spread of infection. Therefore, infection prevention is of utmost importance. The authors believe that cryosurgery should have a place in the treatment of sacrococcygeal chordoma.