Chordoma treatment begins with surgery.
As stated by The Chordoma Foundation “No matter what stage of the disease you are facing [new, recurrent, advanced, metastatic] or where your tumor is located, the way surgery is performed is very important.”
At Stanford, the preferred surgical treatment for most chordomas of the skull base is the Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. Dr. Fernandez-Miranda and his team have been at the forefront of the development and refinement of EEA for skull base chordomas, describing multiple anatomical nuances and novel surgical techniques relevant for successful chordoma surgery.
Depending on the size and location of your tumor, it may be necessary to do surgery from multiple directions to safely remove different parts of the tumor. At Stanford, we have expertise with all types of transcranial skull base approaches for those tumors that cannot be totally removed via EEA.
The goal of the Stanford Skull Base team is to perform, whenever possible, a “supratotal” tumor resection, where the entire tumor is removed along with at least 1 millimeter of healthy tissue around the tumor, and at the same time minimize side effects and surgical complications.
When the entire tumor is successfully removed with surgery, patients statistically live longer and the tumor is less likely to recur, or grow back. If your entire tumor was not successfully removed with the first surgery, consider getting a second opinion on removing the remaining tumor before starting radiation.
Chordomas have a high local recurrence rate, meaning they can come back after successful treatment — usually in the same place as the first tumor. This is called a local recurrence. In selected cases, a reoperation is recommended. At Stanford, we have extensive experience treating patients with chordoma recurrence that were considered “inoperable” at other centers.
Even in cases where all visible tumor has been removed, it is still likely that microscopic chordoma cells were left behind during surgery. Therefore, radiation therapy is generally recommended after surgery to prevent any remaining cells from re-growing or spreading to other parts of the body.
Radiation treatments will typically begin within three to six months after surgery. Radiation delivery techniques with particles (protons or carbon ions) or photons (stereotactic radiosurgery [SRS] and intensity modulated radiation therapy [IMRT]) have allowed for higher doses of radiation to be delivered to the tumor while sparing surrounding structures.
Proton beam, carbon ion, and IMRT photon radiation are typically given in small doses during daily sessions (usually around 35-40) over 6-8 weeks. Hypofractionated radiation like SRS are given in larger doses over a shorter amount of time (usually 1-5 sessions). Once you have been treated with a high dose of radiation, it might not be possible for you to have radiation again.
Chemotherapy uses drugs to stop cancer cells from growing. Modern chemotherapy and immunotherapy for chordomas is under investigation at Stanford Cancer Center.