Treatment of Chordoma with Isolated Local-Regional Relapse at the Skull Base
Isolated local-regional relapse confined to the skull base is a specific and clinically demanding scenario in chordoma. A guideline-based treatment pathway exists for this situation, distinct from management of systemic or distant disease.
Chordoma presenting with isolated local-regional relapse located in the skull base. In this anatomical site, the extent of surgical resection and the planning of radiotherapy carry specific considerations that directly influence local control outcomes.
Management centres on salvage radiotherapy delivered with curative intent, using high-dose re-irradiation. Surgical intervention may also be considered in combination. The full protocol defines modality selection, dosing framework, fractionation approach, and resection goals — none of which are shown in full here.
References
DOI: 10.1093/annonc/mdx054
- Skull-base isolated local-regional relapse.
- For skull-base tumors R1 resection should be the goal of surgical treatment in all cases, in order to reduce tumor volume and increase the effectiveness of subsequent RT (V-A).
- Salvage RT with curative intent should be offered with the same modality employed for first line therapy (V-C).
- Since chordomas are radioresistant, a dose of at least 74 GyE should be delivered, using conventional fractionation (1.8–2 GyE) for photon and proton therapy (V*-A); moderately hypofractionated schedules can be used with carbon ions with dose per fractions ranging between 3 and 4.4 Gy RBE and total doses ranging from 60 and 70.4 Gy RBE.