Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group

S Stacchiotti¹, A Gronchi², P Fossati^{3

4}, T Akiyama⁵, C Alapetite^{6

7}, M Baumann⁸, J Y Blay⁹, S Bolle¹⁰, S Boriani¹¹, P Bruzzi¹², R Capanna¹³, A Caraceni¹⁴, R Casadei¹⁵, V Colia¹, J Debus¹⁶, T Delaney¹⁷, A Desai¹⁸, P Dileo¹⁹, S Dijkstra²⁰, F Doglietto²¹, A Flanagan^{22

23}, S Froelich²⁴, P A Gardner²⁵, H Gelderblom²⁶, Z L Gokaslan²⁷, R Haas²⁸, C Heery²⁹, N Hindi³⁰, P Hohenberger³¹, F Hornicek³², R Imai³³, L Jeys³⁴, R L Jones³⁵, B Kasper³¹, A Kawai³⁶, M Krengli³⁷, A Leithner³⁸, I Logowska³⁹, J Martin Broto³⁰, D Mazzatenta⁴⁰, C Morosi⁴¹, P Nicolai⁴², O J Norum⁴³, S Patel⁴⁴, N Penel⁴⁵, P Picci⁴⁶, S Pilotti⁴⁷, S Radaelli², F Ricchini¹⁴, P Rutkowski³⁹, S Scheipl³⁸, C Sen⁴⁸, E Tamborini⁴⁷, K A Thornton⁴⁹, B Timmermann⁵⁰, V Torri⁵¹, P U Tunn⁵², M Uhl¹⁶, Y Yamada⁵³, D C Weber⁵⁴, D Vanel⁵⁵, P P Varga⁵⁶, C L A Vleggeert-Lankamp⁵⁷, P G Casali¹, J Sommer⁵⁸

Affiliations

¹ Departments of Cancer Medicine.
² Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
³ CNAO National Center for Oncological Hadrontherapy, Pavia.
⁴ Department of Radiotherapy, IEO-European Institute of Oncology, Milan, Italy.
⁵ Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
⁶ Department of Radiotherapy, Institut Curie, Paris.
⁷ Institut Curie-Centre de Protonthérapie d'Orsay (ICPO), Orsay, France.
⁸ Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁹ Cancer Medicine Department, Centre Léon Bérard, Lyon.
¹⁰ Department of Radiotherapy, Gustave Roussy, Villejuif Cedex, France.
¹¹ Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna.
¹² Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova.
¹³ University Clinic of Orthopedics and Traumatology AO Pisa, Pisa.
¹⁴ Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
¹⁵ Orthopedic Department, Rizzoli Institute Bologna, Bologna, Italy.
¹⁶ Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
¹⁷ Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, USA.
¹⁸ Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham.
¹⁹ Department of Oncology, University College London Hospitals (UCLH), London, UK.
²⁰ Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
²¹ Institute of Neurosurgery, University of Brescia, Brescia, Italy.
²² University College London Cancer Institute, London.
²³ Histopathology Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.
²⁴ Department of Neurosurgery, Paris Diderot University, Hôpital Lariboisière, Paris, France.
²⁵ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA.
²⁶ Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
²⁷ Department of Neurosurgery, Brown University School of Medicine, Providence, USA.
²⁸ Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
²⁹ Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, USA.
³⁰ Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
³¹ Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.
³² Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
³³ National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, Chiba, Japan.
³⁴ Department of Orthopaedics, Royal Orthopaedic Hospital Birmingham, Birmingham.
³⁵ Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
³⁶ Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center, Tokio, Japan.
³⁷ Radiotherapy Department, University of Piemonte Orientale, Novara, Italy.
³⁸ Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria.
³⁹ Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
⁴⁰ Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna.
⁴¹ Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
⁴² Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy.
⁴³ Department of Tumor Orthopedic Surgery, The Norwegian Radium Hospital, Oslo, Norway.
⁴⁴ Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, USA.
⁴⁵ Cencer Medicine Department, Oscar Lambret Cancer Centre, Lille, France.
⁴⁶ Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna.
⁴⁷ Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
⁴⁸ Department of Neurosurgery, NYU Langone Medical Center, New York.
⁴⁹ Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
⁵⁰ Particle Therapy Department, West German Proton Therapy Centre Essen, University Hospital Essen, Essen, Germany.
⁵¹ Oncology Unit, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
⁵² Department of Orthopaedic Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
⁵³ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
⁵⁴ Paul Scherrer Institut PSI, Villigen, Switzerland.
⁵⁵ Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
⁵⁶ National Center for Spinal Disorders, Budapest, Hungary.
⁵⁷ Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands.
⁵⁸ Chordoma Foundation, Durham, USA.

PMID: 28184416
PMCID: PMC5452071
DOI: 10.1093/annonc/mdx054

Review

Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group

S Stacchiotti et al. Ann Oncol. 2017.

. 2017 Jun 1;28(6):1230-1242.

doi: 10.1093/annonc/mdx054.

Authors

Affiliations

¹ Departments of Cancer Medicine.
² Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
³ CNAO National Center for Oncological Hadrontherapy, Pavia.
⁴ Department of Radiotherapy, IEO-European Institute of Oncology, Milan, Italy.
⁵ Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
⁶ Department of Radiotherapy, Institut Curie, Paris.
⁷ Institut Curie-Centre de Protonthérapie d'Orsay (ICPO), Orsay, France.
⁸ Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁹ Cancer Medicine Department, Centre Léon Bérard, Lyon.
¹⁰ Department of Radiotherapy, Gustave Roussy, Villejuif Cedex, France.
¹¹ Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna.
¹² Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova.
¹³ University Clinic of Orthopedics and Traumatology AO Pisa, Pisa.
¹⁴ Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
¹⁵ Orthopedic Department, Rizzoli Institute Bologna, Bologna, Italy.
¹⁶ Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
¹⁷ Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, USA.
¹⁸ Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham.
¹⁹ Department of Oncology, University College London Hospitals (UCLH), London, UK.
²⁰ Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
²¹ Institute of Neurosurgery, University of Brescia, Brescia, Italy.
²² University College London Cancer Institute, London.
²³ Histopathology Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.
²⁴ Department of Neurosurgery, Paris Diderot University, Hôpital Lariboisière, Paris, France.
²⁵ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA.
²⁶ Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
²⁷ Department of Neurosurgery, Brown University School of Medicine, Providence, USA.
²⁸ Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
²⁹ Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, USA.
³⁰ Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
³¹ Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.
³² Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
³³ National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, Chiba, Japan.
³⁴ Department of Orthopaedics, Royal Orthopaedic Hospital Birmingham, Birmingham.
³⁵ Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
³⁶ Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center, Tokio, Japan.
³⁷ Radiotherapy Department, University of Piemonte Orientale, Novara, Italy.
³⁸ Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria.
³⁹ Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
⁴⁰ Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna.
⁴¹ Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
⁴² Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy.
⁴³ Department of Tumor Orthopedic Surgery, The Norwegian Radium Hospital, Oslo, Norway.
⁴⁴ Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, USA.
⁴⁵ Cencer Medicine Department, Oscar Lambret Cancer Centre, Lille, France.
⁴⁶ Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna.
⁴⁷ Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
⁴⁸ Department of Neurosurgery, NYU Langone Medical Center, New York.
⁴⁹ Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
⁵⁰ Particle Therapy Department, West German Proton Therapy Centre Essen, University Hospital Essen, Essen, Germany.
⁵¹ Oncology Unit, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
⁵² Department of Orthopaedic Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
⁵³ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
⁵⁴ Paul Scherrer Institut PSI, Villigen, Switzerland.
⁵⁵ Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
⁵⁶ National Center for Spinal Disorders, Budapest, Hungary.
⁵⁷ Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands.
⁵⁸ Chordoma Foundation, Durham, USA.

PMID: 28184416
PMCID: PMC5452071
DOI: 10.1093/annonc/mdx054

Abstract

Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper.

Keywords: chemotherapy; chordoma; radiotherapy; relapse; sarcoma; surgery.

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Figures

**Figure 1.**
Flow-charts summarizing the recommended treatment strategy for patients with local-regional recurrence. MR, magnetic resonance; CT, computerized tomography; prog., progressioni; WB, whole body; REF, reference; RT, radiotherapy.

See this image and copyright information in PMC

References

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Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group

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Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group

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