Multidisciplinary management of recurrent chordomas.

OPINION STATEMENT: The management of recurrent chordomas are clinically challenging because of its relentless nature. Local therapy, whether surgery or radiation, are important considerations since local progression of disease results in significant morbidity and locally aggressive treatment is often required. Stereotactic radiosurgery, shown to be very effective for radioresistant histologies, may be an important radiotherapeutic approach for recurrent tumors. Ultimately, the treatment of recurrent chordoma is palliative in intent, thus, enthusiasm for improving local control must be tempered against the possible impact of treatment on quality of life. Judicious use of radiotherapy and surgery can often provide meaningful palliation and local control of recurrences. Systemic treatment options, particularly with targeted molecules have great potential for chordomas in the recurrent setting, as the risk of disseminated disease is higher. The development of tools to help assess potential targets for drug therapy will be crucial. The incorporation of locally aggressive therapy and effective systemic therapy will be critical for the successful management of recurrent chordomas. At present, there is a paucity of published data regarding salvage therapy. Nonetheless, advances in surgical, medical, and radiation oncology are providing new avenues of research and potentially may have significant impact upon successful salvage treatment.