Chordoma Foundation

Guidelines for skull base isolated recurrence 

The treatment recommendations you find here were developed by the Chordoma Global Consensus Group – a multidisciplinary, 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.


The following flow chart illustrates the possible options for a skull base isolated recurrence, as discussed in the sections below.

Expert Recommendations Recurrent Chordoma Flow Chart

View/download flow chart as a PDF »


As discussed in the previous section, your doctors should first determine whether you are able to have high-dose radiation treatments, based on what radiation treatments you have had in the past. It is important for a radiation oncologist who has experience treating skull base chordoma to examine your past radiation treatment plans in relation to the current tumor growth to make this determination.

If your doctors determine that you are able to have high-dose radiation, surgery should also be considered in order to help increase the effectiveness of radiation. If surgery is not possible, high-dose radiation alone can be considered. There is very little data comparing the effectiveness of surgery plus radiation versus radiation alone for recurrent skull base tumors. These options should be discussed in detail with your doctors.

If your doctors determine that you are unable to have high-dose radiation and your tumor is progressing or you are experiencing symptoms, it is recommended that you consider other treatment options such as debulking surgery, low-dose radiation, or systemic therapy.

Read more about these treatment options »

A comprehensive palliative and supportive care 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 tumor is slow-growing or you are not experiencing symptoms, your doctors might recommend a period of observation before treatment.

Goals of surgery for skull base isolated recurrence

In general, the goal of surgery for recurrent skull base tumors is complete resection. However, this is often not possible for tumors in this area. In these cases, debulking surgery to remove as much of the tumor as possible can be considered. Debulking surgery may be performed in order to reduce the amount of tumor that needs to be radiated or to separate the tumor from healthy tissues to make radiation safer. Debulking surgery may also be performed to alleviate symptoms. However, without radiation it is unlikely to control the tumor.

Your doctors should be cautious with surgery because the chance of serious side effects increases with each additional surgery.



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. 

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