Treatment of Chordoma with Isolated Local-Regional Relapse in the Mobile Spine or Sacrum
This page covers the management of chordoma that has relapsed in an isolated local-regional pattern within the mobile spine or sacrum, specifically in patients who remain eligible for surgery with curative intent.
Clinical Scenario
The patient has chordoma with isolated local-regional relapse at the mobile spine or sacrum. Eligibility for re-resection with curative intent requires the absence of all three of the following: prior piecemeal resection, prior tumor rupture, and prior high-dose radiotherapy to the affected site. Any one of these factors is an exclusion criterion for the curative surgical approach.
Treatment Approach
For eligible patients, the management centres on salvage surgery with curative intent, targeting en-bloc resection with negative surgical margins. Radiotherapy may also have a role depending on margin status and prior radiation history — the complete evidence-based protocol, including sequencing and all relevant considerations, is available via the link below.
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).
- For mobile spine and sacral tumors, the goal of salvage surgery with curative intent should be to achieve en-bloc resection with negative surgical margins (IV-B).
- When no prior RT had been delivered, post-operative RT should be considered, especially when microscopic margins were positive/R1.
- A component of preoperative RT can also be considered.