Treatment of Chordoma with Isolated Local-Regional Relapse in the Mobile Spine or Sacrum After Piecemeal Resection, Tumor Rupture, or Prior High-Dose Radiotherapy
This protocol applies to chordoma that has recurred in a localised fashion within the mobile spine or sacrum in patients whose prior treatment history specifically excludes curative re-resection as an option.
Clinical scenario
The defining features are an isolated local-regional relapse at the mobile spine or sacrum combined with at least one of the following prior histories: piecemeal resection, tumor rupture, or high-dose radiotherapy to the same region. Each of these factors is an established exclusion criterion for re-resection with curative intent, redirecting the clinical approach toward palliative management.
Treatment approach (partial overview)
The strategy combines palliative loco-regional interventions with best supportive care, and may incorporate systemic therapy. A range of loco-regional modalities and systemic options is available; the structured selection between them depends on individual patient factors detailed in the full protocol.
Primary goal: pain control / reduction of pain
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).
- 'Salvage palliative/supportive treatment choices' include debulking surgery, low-dose RT, stereotactic body RT (SBRT), including radiosurgery to small volume, radiofrequency ablation (RFA) and other loco-regional approaches (i.e. cryotherapy), systemic therapy, PC and observation.
- Retrospective data suggest that cryoablation and RFA can be safe and useful palliative treatments in recurrent extracranial chordomas with a benefit in pain control.
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