title: Case report: Successful treatment of recurrent chordoma and bilateral pulmonary metastases following an 11-year disease-free period.
abstract: BACKGROUND
  Chordomas are rare but aggressive tumors due to local recurrence and distant metastases. They originate commonly in the sphenooccipital and sacrococcygeal regions, and metastasize to the lungs, bone, skin, liver, and lymph nodes. They occur more frequently in men and people over the age of 40.
  
  
  METHODS
  A 28 year-old female presented with sacrococcygeal chordoma for which she received wide local excision and adjuvant radiation therapy. She enjoyed an unusual disease-free survival for 11 years until a routine surveillance scan of the pelvis identified local recurrence. Further work up revealed bilateral pulmonary metastases. She underwent local excision of the recurrent tumor and video-assisted thoracoscopic (VATS) wedge resection of pulmonary metastases. She also received adjuvant radiation therapy to the recurrent resection bed. Two years later, she remains free of disease and symptoms.
  
  
  CONCLUSIONS
  Chordomas are commonly insensitive to chemotherapy and radiation, making surgery the most successful therapeutic modality. However, there are few guidelines on the surveillance and treatment of recurrent chordoma. We report success with aggressive surgical resection of recurrence and metastasis as well as adjuvant radiation therapy.
  
  
  CONCLUSIONS
  The prolonged survival of our patient underscores the importance of (1) aggressive surgical resection of chordoma, whether primary, recurrent, or metastatic, with adjuvant radiation therapy, (2) minimization of surgical seeding of tumor, and (3) diligent cancer surveillance.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States. Electronic address: Cherie.P.Erkmen@Hitchcock.org.
authors.forename: Cherie P
authors.initials: CP
authors.lastname: Erkmen
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Barth
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States.
authors.forename: Vignesh
authors.initials: V
authors.lastname: Raman
keywords: Chordoma; Metastasis; Recurrence