Recurrent and metastatic clivus chordoma: systemic palliative therapy retards disease progression.
We report on a male patient with progressive and metastatic clivus chordoma treated over a period of 9 years by a multidisciplinary approach. Within the first 4 years, the patient underwent surgery four times. Thereafter, he received radiotherapy and subsequent chemotherapy. Stabilization of disease was achieved repeatedly for variable periods under local radiotherapy, systemic chemotherapy, immunomodulatory and anti-angiogenic therapy with isotretinoin and interferon-alpha, followed by thalidomide. Due to the occurrence of brain and lung metastases 8 years after initial diagnosis, liposomal doxorubicin was added to thalidomide. At the last follow-up control the patient had stable disease, with no progression of the intracranial tumor and regression of pulmonary metastases. He is in a good physical, psychological and neurological condition with a Karnofsky score of 80. Our observations show that multimodal therapy including a systemic palliative approach is associated with long quiescent intervals in recurrent chordoma and with regression of its metastases. Use of substances with high efficacy on tumor tissue and low toxicity, allowing long-term administration, seems promising in similar situations.
Schönegger
Katharina
K
Clinical Division of Oncology, Department of Medicine I, Medical University Vienna, General Hospital (AKH), Vienna, Austria.
Gelpi
Ellen
E
Prayer
Daniela
D
Dieckmann
Karin
K
Matula
Christian
C
Hassler
Marco
M
Hainfellner
Johannes A
JA
Marosi
Christine
C
D002817:Chordoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care; D011859:Radiography; D012008:Recurrence; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome