الوتر العظمي في العمود الفقري المتحرك أو العجز: الانتكاس الموضعي-الإقليمي المعزول بعد الاستئصال التجزيئي أو تمزق الورم أو العلاج الإشعاعي ذي الجرعة العالية السابق

References

DOI: 10.1093/annonc/mdx054

Mobile spine/sacrum isolated local-regional relapse. A prior history of piecemeal resection (except for skull-base tumors where resection may be necessarily piecemeal), prior high-dose RT (in case of mobile spine and sacral chordoma), and/or tumor rupture are obvious exclusion criteria for re-resection with curative intent (IV-B).

In the case of recurrent disease after previous RT, a new course of RT is indicated only when (i) this can be delivered without exceeding the estimated dose constraints on organs at risk (OARs) and (ii) adequate coverage of target volumes can be achieved.

If a new course of high-dose RT can be delivered without exceeding the estimated dose constraints on OARs, the patient should be treated with the same intent and approach as a RT naïve recurrence (V-C).

The use of high Linear Energy Transfer (LET) radiation such as carbon ions can be considered especially in case of re-irradiation after an initial course of low LET treatment as it may be more effective against the radioresistant clones that may have been selected by the first treatment.