Our Program

The USC Chordoma Center at Keck Medicine of USC in Los Angeles offers complete management for the special type of spinal tumor known as a chordoma. Chordomas are rare cancerous tumors that can occur anywhere along the spine, but most often are found either at the top (skull base) or bottom (sacrum) of the spine. As a chordoma grows, it can cause pain and weakness or numbness in the back, arms or legs. A chordoma located at the top of the spine can lead to double vision and headaches. It is also possible for a chordoma to spread to other parts of the body.

Advanced surgical treatment is offered with the intent to eradicate the chordoma whenever possible. Surgical therapy is based on the newest techniques in microdissection and image guidance using neuronavigational therapy. If it is determined the tumor is too difficult to reach with surgery, the alternative is radiation therapy. Keck Medicine of USC has facilities featuring the latest advances in this area, such as the Gamma Knife® and CyberKnife®. Therapies including intensity-modulated radiation therapy are also available.

Our Approach

Our philosophy is to provide the best multidisciplinary treatment possible, with our aim being to cure the disease. Our patients benefit from a multi-disciplinary network of neuro-oncology professionals, including experts in medical oncology, neurosurgery, radiation oncology, neuropathology and neuroradiology. Patients will receive attention to any medical and surgical needs that may arise before or during treatment, as well as follow-up after the procedure.

As chordoma is a very rare disease, most physicians may see only one or two cases in their career. Our physicians regularly see patients who have chordoma, giving us the knowledge and experience needed to design and implement a proper treatment plan. Our oncologists are renowned experts in chordoma and sarcoma, and we offer ongoing clinical trials and protocols for treatment.

We are among only a few institutions in the United States to offer treatment for chordoma and the only center in the greater southwest region to offer en bloc sacrectomy and spinal tumor resection that has been shown to improve long-term survival and provide the best chance for cure.

Conditions

Chordomas are tumors that can occur anywhere along the spine. Most often they are found at the top of the spine (skull base or clival) or at the base of the spine (sacral). They are less frequently found in the neck (cervical), upper back (thoracic) or lower back (lumbar). These tumors are typically slow growing but can become aggressive in some cases.

There are three subtypes of chordoma:

  • Chondroid
  • Conventional (classic)
  • Dedifferentiated

Dedifferentiated chordomas are the most aggressive, fastest growing of the three subtypes and are the most likely to metastasize to another area of the body. Chondroid chordomas are typically the least aggressive.

The preferred method of treatment at Keck Medical Center of USC is to completely remove the chordomas. The tumor will be surgically removed if it can be accessed without damaging surrounding structures. If it can’t be removed by surgery, radiation therapy will be used.

The USC Chordoma Center has cutting-edge stereotactic radiosurgery facilities including the Gamma Knife®, CyberKnife® and TrueBeam™ STx. Intensity-modulated radiation therapy are also available. These methods deliver a high dose of radiation to only the unhealthy tissue, avoiding the healthy tissue that surrounds it.

Treatments

The USC Chordoma Center offers advanced surgical treatment as the initial approach to completely removing the chordoma. Surgery utilizes the newest techniques in microdissection and image guidance to achieve a successful outcome. The center uses procedures not available at any other facility in the area to provide the best chance for a cure.

If it is determined that surgical removal of the tumor will likely cause too much harm to the patient, radiosurgery is the next option. As with surgical techniques, USC utilizes state-of-the-art modalities and techniques to precisely target the tumor with minimal damage to surrounding tissue.

Surgical treatments

  • En bloc sacrectomy
    The USC Chordoma Center is the only facility in the greater southwest region of the United States to perform this procedure, in which a portion of the sacrum (base of the spine) is resected to allow full access for removal of the tumor.
  • Spinal tumor resection
    In this procedure, soft tissue and lamina (a posterior bony structure that covers the spinal canal) are removed, so that the tumor can then be separated from healthy tissue and removed.
  • Endoscopic skull base tumor resection
    In this minimally-invasive procedure the endoscope (a device providing lighting and visualization) and other instruments are inserted through the nose, eliminating the need for an incision and the resulting scar. This approach allows access to the base of the skull from the bottom rather than the top as is the case with traditional craniotomy, and thus avoids potential damage to other important anatomical structures, such as the brain.

Nonsurgical treatments

  • Gamma Knife® Radiosurgery
    The Gamma Knife® is not a knife, but rather is a precise way of delivering radiation to a precisely-defined area (the tumor) while minimizing damage to surrounding tissue in the brain. Many small beams of radiation are delivered through different parts of the brain and come together in a strong dose directly to the tumor.
  • CyberKnife® Radiosurgery
    The CyberKnife® also delivers radiation directly to the carefully defined tumor, without damage to other tissue. This is a frameless method in which the patient’s head does not need to be contained in a rigid frame.
  • Intensity Modulated Radiation Therapy
    In this treatment, doctors are able to regulate the intensity of the beams of radiation, so that the strongest beams arrive directly to the tumor, and healthy tissue that the beams travel through to get to the tumor receives much less of a dose.

Resources

Chordoma Foundation
chordomafoundation.org

Cancer.net
cancer.net

American Academy of Orthopaedic Surgeons – Chordoma Page
orthoinfo.aaos.org

Support Groups

Cancer Support Community
cancersupportcommunity.org

The National Cancer Institute’s Directory of Support Services
supportorgs.cancer.gov

Caregiver Action Network – Resources and Support for Caregivers
caregiveraction.org

Our Physicians

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Practicing Locations

Keck Hospital of USC
USC Healthcare Center 4
USC Norris Comprehensive Cancer Center and Hospital
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Practicing Locations

Keck Hospital of USC
Keck Medicine of USC - Pasadena
USC Healthcare Center 4
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Practicing Locations

Keck Hospital of USC
USC Healthcare Center 2
USC Norris Comprehensive Cancer Center and Hospital

Specializing In

Tumors of the Musculoskeletal System in Adults and Children, Musculoskeletal Infection, Limb Sparing Tumor Surgery

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Practicing Locations

Keck Hospital of USC
USC Healthcare Center 2
USC Norris Comprehensive Cancer Center and Hospital