Treatment of Chordoma with Multinodular or Multifocal Local-Regional Relapse
This page addresses chordoma that has relapsed in a multinodular or multifocal local-regional pattern, as well as locally relapsed chordoma where neither surgery nor high-dose radiotherapy remains a feasible option.
In this setting, multifocal disease makes curative resection inappropriate. The clinical priority shifts to preventing the consequences of progression and preserving function — a cure is virtually impossible, and re-resection with curative intent should not be performed. Only limited resection aimed at preventing progression-related complications may be considered.
Management follows active palliative care principles. Depending on the individual clinical picture, a combination of loco-regional approaches and, where appropriate, systemic therapy may be considered — the full range of options and their sequencing is detailed in the complete protocol.
Primary clinical goal: Pain control and reduction of pain.
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.
- '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.
- Medical therapy is an appropriate palliative option for patients whose disease is actively progressing or who are symptomatic.
- Retrospective data suggest that cryoablation and RFA can be safe and useful palliative treatments in recurrent extracranial chordomas with a benefit in pain control.