Guidelines for sacral and mobile spine isolated recurrence
 The treatment recommendations you find here were developed by the Chordoma Global Consensus GroupA multidisciplinary, international group of over 60 doctors who have extensive experience caring for chordoma patients. The group is responsible for developing and publishing consensus guidelines, based on all available medical and scientific evidence, for the treatment of primary and recurrent chordoma. – a multidisciplinaryTreatment that involves a team of physicians from various disciplines. In the case of chordoma, these disciplines include sarcoma or bone pathology, radiology, spine surgery or skull base surgery, otolaryngology, radiation oncology, medical oncology, and palliative care., international group of more than 60 doctors who specialize in caring for chordoma patients. The Chordoma Foundation and the European Society for Medical Oncology brought this group together to define the recommendations for treating chordoma based on all available medical and scientific evidence. The resulting consensus guidelines were published in the medical journal Annals of Oncology in June 2017. The full paper can be accessed here. You can also find these recommendations in our Expert Recommendations for the Treatment of Recurrent Chordoma booklet. Download or request a hard copy of the booklet »
A series of flowcharts helps to illustrate the treatment guidelines and walk you through the suggested tests, treatment options, and follow-up steps recommended for different recurrence scenarios. You’ll find the flowcharts and supporting information throughout the page below. You can also download the collection of flowcharts as a PDF. |
For sacral and mobile spineThe parts of the spine not including the sacrum. The cervical spine (neck), thoracic spine (upper back), and lumbar spine (lower back) are the parts of the mobile spine. (cervicalThe seven vertebrae that make up the neck. These vertebrae are commonly referred to as C1-C7., thoracicThe twelve vertebrae of the upper and mid back, extending from the shoulders to the bottom of the rib cage. These bones are commonly referred to as T1-T12., and lumbarThe five vertebrae of the lower back, commonly referred to as L1-L5.) recurrences, your doctors should first consider:
- whether your tumor ruptured during previous surgery or was taken out in more than one piece
- what radiation treatments you have received
This will help determine whether surgery alone, surgery plus radiation, or radiation alone is the best option for you. It is important for a radiation oncologist who has experience with chordoma to examine any past radiation treatment plans in relation to your current tumor growth to make this determination.
The following flow chart illustrates the possible options for a mobile spine or sacral isolated recurrenceA single recurrent tumor at or near the site of the original tumor., as discussed in the sections below.
View/download flow chart as a PDF »
If your original tumor was completely removed in one piece (en-bloc resection) and:
| You have not had radiation, surgery to remove the entire tumor should be considered first.
| You have had radiation, your doctors will need to determine whether you can have further high-dose radiation.
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The following flow chart illustrates the possible options for a mobile spine or sacral isolated recurrenceTumor that has grown back after initial treatment. Recurrences can be isolated or multifocal, local or regional., as discussed in the sections below.
View/download flow chart as a PDF »
If your original tumor ruptured during previous surgery or was taken out in more than one piece (not en-bloc), your doctors will need to determine whether you can receive high-dose radiation.
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Read more about options to consider if high-dose radiation is not possible »
A comprehensive palliative and supportive careCare given to improve the quality of life of patients who have a serious or life-threatening disease. plan should be part of your overall treatment plan, to help address any side effects or other quality of life concerns and provide support for you and your family members.
Read more about palliative and supportive care »
If your doctors are unsure of the best treatment option for you, a period of observation is recommended if your disease is stable, your tumor is slow-growing, or you do not have noticeable symptoms.
Goals of surgery for sacral and mobile spine isolated recurrenceIn general, the goal of surgery for sacral or mobile spine tumors is to remove the tumor in one piece (en-bloc resection) with surgical marginsThe healthy tissue surrounding the tumor that is taken out along with the tumor to make sure that no cancer cells are left behind. Negative or wide margins mean no tumor cells can be detected in the healthy tissue, which lowers the chance of recurrence. of at least 1mm of healthy tissue. It is very important that all attempts are made to limit the risk of rupturing the tumor during surgery, which can cause tumor cells to spread. Recurrences within the chest cavity, abdomen, and pelvis cannot typically be removed in one piece. The goal of surgery in these cases is to remove as much of the tumor as possible to increase the effectiveness of later radiation. |
The information on this page was developed by the Chordoma Foundation in consultation with members of the Chordoma Global Consensus Group. We would like to thank the members of the Chordoma Global Consensus Group for providing their expertise in the development of the original consensus guidelines and their review of this educational content.
The information provided herein is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your or your loved one’s physician about any questions you have regarding your or your loved one’s medical care. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website.