title: Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group.
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.
authors.affiliation: Departments of Cancer Medicine.
authors.forename: S
authors.initials: S
authors.lastname: Stacchiotti
authors.affiliation: Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
authors.forename: A
authors.initials: A
authors.lastname: Gronchi
authors.affiliation: CNAO National Center for Oncological Hadrontherapy, Pavia.|Department of Radiotherapy, IEO-European Institute of Oncology, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Fossati
authors.affiliation: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Department of Radiotherapy, Institut Curie, Paris.|Institut Curie-Centre de Protonthérapie d'Orsay (ICPO), Orsay, France.
authors.forename: C
authors.initials: C
authors.lastname: Alapetite
authors.affiliation: Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Baumann
authors.affiliation: Cancer Medicine Department, Centre Léon Bérard, Lyon.
authors.forename: J Y
authors.initials: JY
authors.lastname: Blay
authors.affiliation: Department of Radiotherapy, Gustave Roussy, Villejuif Cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Bolle
authors.affiliation: Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna.
authors.forename: S
authors.initials: S
authors.lastname: Boriani
authors.affiliation: Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova.
authors.forename: P
authors.initials: P
authors.lastname: Bruzzi
authors.affiliation: University Clinic of Orthopedics and Traumatology AO Pisa, Pisa.
authors.forename: R
authors.initials: R
authors.lastname: Capanna
authors.affiliation: Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
authors.forename: A
authors.initials: A
authors.lastname: Caraceni
authors.affiliation: Orthopedic Department, Rizzoli Institute Bologna, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Casadei
authors.affiliation: Departments of Cancer Medicine.
authors.forename: V
authors.initials: V
authors.lastname: Colia
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, USA.
authors.forename: T
authors.initials: T
authors.lastname: Delaney
authors.affiliation: Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham.
authors.forename: A
authors.initials: A
authors.lastname: Desai
authors.affiliation: Department of Oncology, University College London Hospitals (UCLH), London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Dileo
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Dijkstra
authors.affiliation: Institute of Neurosurgery, University of Brescia, Brescia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Doglietto
authors.affiliation: University College London Cancer Institute, London.|Histopathology Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.
authors.forename: A
authors.initials: A
authors.lastname: Flanagan
authors.affiliation: Department of Neurosurgery, Paris Diderot University, Hôpital Lariboisière, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Froelich
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Gardner
authors.affiliation: Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Gelderblom
authors.affiliation: Department of Neurosurgery, Brown University School of Medicine, Providence, USA.
authors.forename: Z L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Haas
authors.affiliation: Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, USA.
authors.forename: C
authors.initials: C
authors.lastname: Heery
authors.affiliation: Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Hindi
authors.affiliation: Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Hohenberger
authors.affiliation: Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: F
authors.initials: F
authors.lastname: Hornicek
authors.affiliation: National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, Chiba, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Imai
authors.affiliation: Department of Orthopaedics, Royal Orthopaedic Hospital Birmingham, Birmingham.
authors.forename: L
authors.initials: L
authors.lastname: Jeys
authors.affiliation: Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
authors.forename: R L
authors.initials: RL
authors.lastname: Jones
authors.affiliation: Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Kasper
authors.affiliation: Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center, Tokio, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kawai
authors.affiliation: Radiotherapy Department, University of Piemonte Orientale, Novara, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Krengli
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Leithner
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: I
authors.initials: I
authors.lastname: Logowska
authors.affiliation: Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Martin Broto
authors.affiliation: Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna.
authors.forename: D
authors.initials: D
authors.lastname: Mazzatenta
authors.affiliation: Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
authors.forename: C
authors.initials: C
authors.lastname: Morosi
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Nicolai
authors.affiliation: Department of Tumor Orthopedic Surgery, The Norwegian Radium Hospital, Oslo, Norway.
authors.forename: O J
authors.initials: OJ
authors.lastname: Norum
authors.affiliation: Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, USA.
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.affiliation: Cencer Medicine Department, Oscar Lambret Cancer Centre, Lille, France.
authors.forename: N
authors.initials: N
authors.lastname: Penel
authors.affiliation: Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna.
authors.forename: P
authors.initials: P
authors.lastname: Picci
authors.affiliation: Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pilotti
authors.affiliation: Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
authors.forename: S
authors.initials: S
authors.lastname: Radaelli
authors.affiliation: Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan.
authors.forename: F
authors.initials: F
authors.lastname: Ricchini
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Rutkowski
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Scheipl
authors.affiliation: Department of Neurosurgery, NYU Langone Medical Center, New York.
authors.forename: C
authors.initials: C
authors.lastname: Sen
authors.affiliation: Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Tamborini
authors.affiliation: Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Thornton
authors.affiliation: Particle Therapy Department, West German Proton Therapy Centre Essen, University Hospital Essen, Essen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Timmermann
authors.affiliation: Oncology Unit, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Torri
authors.affiliation: Department of Orthopaedic Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
authors.forename: P U
authors.initials: PU
authors.lastname: Tunn
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Uhl
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Paul Scherrer Institut PSI, Villigen, Switzerland.
authors.forename: D C
authors.initials: DC
authors.lastname: Weber
authors.affiliation: Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Vanel
authors.affiliation: National Center for Spinal Disorders, Budapest, Hungary.
authors.forename: P P
authors.initials: PP
authors.lastname: Varga
authors.affiliation: Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: C L A
authors.initials: CLA
authors.lastname: Vleggeert-Lankamp
authors.affiliation: Departments of Cancer Medicine.
authors.forename: P G
authors.initials: PG
authors.lastname: Casali
authors.affiliation: Chordoma Foundation, Durham, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sommer
mesh_terms: D002817:Chordoma / Q000628:therapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D017410:Practice Guidelines as Topic
keywords: chemotherapy; chordoma; radiotherapy; relapse; sarcoma; surgery