Treatment of a Chordoma
Eric Shinohara, MD, MSCI Radiation Oncology Section Editor for OncoLink responds:
Thank you for your question.
Chordomas are rare tumors that account for 2% of all primary central nervous system tumors. Chordomas occur primarily at two places: the base of the skull or the end of the spine. They are extradural, occur most commonly in young patients (third and fourth decades of life), and are usually benign (i.e. do not spread throughout the body). However, chordomas may be locally invasive, and frequently invade adjacent bone.
For chordomas located at the end of the spine, complete surgical resection is usually possible and is the treatment of choice. Chordomas located at the base of the skull are often difficult to completely excise, and a combination of surgery followed by radiation is the usual treatment. Aggressive treatment upfront is generally recommended, as tumor recurrence often responds poorly to retreatment. Chordomas in the base of skull can abut several critical organs which can be damaged by surgery or radiation, such as the optic nerves, brainstem and spinal cord. There has been great interest in using proton therapy in chordomas, as the physical properties of protons may provide better coverage of the chordoma while limiting dose to the above-mentioned critical structures. Learn more about the difference between proton and photon therapy here. Learn more about how protons can be used to reduce toxicity here. The centers with the most experience treating chordomas with proton therapy in the United States are at Massachusetts General Hospital in Boston, MA and at Loma Linda University, CA. Both of these centers have published their experiences with treating chordomas using protons, and their results have suggested that higher doses of radiation can be delivered safely using proton therapy.
Massachusetts General Hospital and Loma Linda University near Los Angeles, CA have the largest experience with proton therapy. However, there are presently three new proton facilities which are operational: the MD Anderson Cancer Center in Houston, TX, the University of Florida in Jacksonville, FL, and Indiana University of Indiana in Bloomington, IN. There are also a number of new facilities which are under construction, including at the Hospital of the University of Pennsylvania.