Multinodular or Locally Relapsed Chordoma Not Amenable to Surgery or High-Dose Radiotherapy
Clinical Scenario
This protocol addresses chordoma presenting with multinodular (multifocal) local-regional relapse, or locally relapsed chordoma in which curative surgery and high-dose radiotherapy are no longer feasible options.
Key Clinical Consideration
In multifocal disease, a cure is virtually impossible and re-resection with curative intent is not appropriate. The focus shifts to preserving function and managing the effects of disease progression, with the pace of disease and symptom burden guiding decision-making.
Approach — Partial Overview
For asymptomatic patients with stable or slow-growing disease, a surveillance-oriented approach alongside best palliative care is one component of management. Active treatment may be appropriately deferred when disease is not progressing and symptoms are absent.
The full evidence-based regimen, decision criteria, and complete management algorithm are available via the link below.
References
DOI: 10.1093/annonc/mdx054
- Multinodular local-regional relapse
- In cases of multifocal disease, a cure is virtually impossible so re-resection with curative intent should not be performed (IV-B); in these cases, only a limited resection should be considered with the goal of preventing the ill effects associated with disease progression whilst preserving function.
- In particular, postponing active therapy can be considered in case of stable disease and/or no progression of symptoms.
- If no progression is detected, it may be more appropriate to continue with active surveillance.
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