Chordoma Foundation

Treatment guidelines for newly diagnosed chordoma

The treatment recommendations you find here were developed by the Chordoma Global Consensus Group – a multidisciplinary, international group of over 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 The Lancet Oncology in February 2015.

You can also find these recommendations in our Expert Recommendations for the Diagnosis and Treatment of Chordoma booklet.

Download or request a hard copy of the booklet »


Finding the right medical team

If chordoma is suspected or has been diagnosed, the most important thing to do is find a medical center with expertise in treating chordoma patients. Chordoma is a rare disease that requires expertise to treat properly. It is important to have a multidisciplinary medical team that includes multiple specialists who work together to coordinate your care. All members of the care team should have substantial experience treating tumors of the skull base and spine, including chordoma.

Your care team should include specialists with experience diagnosing and treating chordoma in the following areas:

  • Radiology
  • Pathology
  • Surgery
  • Radiation oncology
  • Medical oncology
  • Palliative care

It is also recommended that your doctors discuss your case in a multidisciplinary tumor board. This is a regular meeting where different specialists come together to review each patient’s case and develop the best treatment plan. As a patient, you benefit from the knowledge and experience of many experts instead of just one or two. This is very important for treating a complicated disease like chordoma.

stethoscopeFind an expert

To help you find the best care possible we have organized a list of chordoma experts you can search by specialty, location, and key terms.

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Getting a diagnosis

If you’ve been told you might have chordoma, it is important to be evaluated by a multidisciplinary team of specialists who have substantial experience treating chordoma, even before you know for sure if you have it. Teams with this experience are typically only found at larger hospitals, sometimes called referral centers, which see large numbers of patients. You should avoid having a biopsy or surgery to confirm the diagnosis outside of a referral center because, if not done properly, these procedures can cause the chordoma to spread.

Read more about diagnosing chordoma »

Get the best care possible

No matter the stage of your disease, there are some important points to keep in mind while you are learning about your options and making decisions.

Read more »


Chordoma tumors are typically detected through imaging tests, which show organs and other structures inside the body, including tumors. The way the tumor looks on imaging tests can tell a radiologist whether the tumor might be chordoma.

When a chordoma is suspected, you will need magnetic resonance imaging, also called MRI, to help doctors make a diagnosis and plan for treatment. This is the best way to see a chordoma and how it is affecting the tissue around it, such as muscles, nerves, and blood vessels. No matter where the tumor is located, an MRI of the entire spine should be performed to see if the tumor may have spread to or developed in other areas of the spine. Chordoma is best seen on an MRI with a setting called T2 weighted imaging.

Another imaging test called computed tomography, also known as CT or “CAT” scan, is recommended in addition to MRI if it is not certain whether the tumor is chordoma. CT scans of the chest, abdomen, and pelvis are also recommended.

In some cases, doctors may order a positron emission tomography, or PET, scan. These are usually whole-body scans that look for widespread tumor activity. PET scans provide information about your body’s metabolic function; for cancer specifically, PET scans pick up on tumors that are rapidly using glucose (sugar). Cancer cells metabolize much more glucose than regular cells, so tumors “light up” on the scan. Because chordoma cells typically grow slowly, however, they are not always picked up as well by PET scans, so they are not always used in chordoma diagnosis or treatment.

These images should be interpreted by a radiologist who has experience diagnosing bone tumors.


While imaging studies can show the possibility of a chordoma, a definitive diagnosis can only be made by a pathologist who examines a sample of tumor tissue under a microscope.

For this reason, your medical team may consider taking a small sample of tissue from the tumor, called a biopsy, prior to surgery. However, biopsies are not recommended if the tumor cannot be reached safely or when there is a high risk of spreading tumor cells. For sacral and mobile spine tumors, a trocar CT-guided biopsy is recommended and should be done from the back.

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Trocar CT-guided biopsy uses a CT scan to precisely direct the biopsy needle to the correct location. The biopsy needle is enclosed in a tube to keep tumor cells from spreading along the path of the needle — this is often called seeding. Check with your doctors to make sure they will use this method if a biopsy is planned.

If you have a biopsy before surgery, it is recommended that your surgeon remove the tissue around the area of the biopsy during surgery in order to remove any chordoma cells that might have spread when the biopsy disturbed the tumor.


Tissue samples should be evaluated by a pathologist who has experience diagnosing bone tumors. Your pathologist should test your tumor tissue for the presence of a protein called brachyury. Nearly all chordomas have high levels of brachyury, which makes it helpful for diagnosis.

The Chordoma Foundation Medical Advisory Board suggests that chordoma patients under 35 years of age, or whose tumors are growing unusually fast, have their tumors tested for loss of INI1, either through immunohistochemistry (IHC) or genomic testing. If tissue is not available for testing, the possibility of a biopsy to obtain tissue for this testing should be discussed with a doctor who has experience treating chordoma, carefully weighing the potential risks of biopsy. Interpretation of the testing should be done by a pathologist who has experience diagnosing chordoma.

Read more about chordoma in children and young adults »


Treatment overview

After you are diagnosed with chordoma you will most likely need to have surgery, radiation, or both. These treatment methods have the potential to cure some chordoma patients if done properly. The Consensus Group’s recommendations vary based on where the tumor is located. Use the buttons below to find recommendations for surgery and radiation for your tumor location.

If you have already had initial treatment outside of a referral center

Regardless of what initial treatment you may have had, it is still very important to be evaluated at a referral center as soon as possible. In particular, it is a good idea to have a sample of your tumor sent to a referral center where an expert pathologist can confirm the diagnosis.




Individualized treatment plan

Each patient’s situation is different, so you should talk with your doctors about the course of treatment that makes the most sense for you. Your doctors can help you understand all the treatment options that are available to you, and create an individualized treatment plan based on your choices.

Value of multiple opinions

Getting multiple opinions from doctors who have experience with chordoma can help you make the most informed decision about your treatment. The Chordoma Foundation Doctor Directory provides information for doctors who have this experience.

Patient Navigation ServiceRequest help

A Chordoma Foundation Patient Navigator can help you find doctors who have experience with chordoma. Our Patient Navigators are available Monday through Friday from 8 AM to 5 PM Eastern Time.

Contact a Patient Navigator »


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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