Chordoma: lines of therapy

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3 standard-of-care settings across 3 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	EGFR
Early / localised	1	·
Locally advanced	1	·
Advanced, first line	·	1

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Resectable, any site	En bloc resection with negative margins by a spine or skull-base team, followed by high-dose proton or carbon-ion radiotherapy; intralesional surgery is associated with early recurrence.	Proton therapyCarbon-ion therapyIMRT / IGRT (modern external beam)	NCCN · Category 2A	93

Locally advanced

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Unresectable or medically inoperable	Definitive particle therapy (proton or carbon-ion) to 70 Gy-equivalent or higher; stereotactic photon radiosurgery where particles are unavailable.	Proton therapyCarbon-ion therapySBRT / SABR (stereotactic radiotherapy)		40

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
EGFR	Advanced or metastatic	Clinical trial preferred. Imatinib (PDGFRB-positive), afatinib or other EGFR inhibitors, or sorafenib give mainly disease stabilisation; tazemetostat was used for INI1-negative poorly differentiated chordoma until Ipsen withdrew it from all markets in March 2026.	ImatinibAfatinibSorafenibTazemetostatSmall-molecule kinase inhibitors		98

Sequence and caution pairings

CautionEstablished

Caution: proton therapy vs IMRT

Protons stop inside the tumour; modern X-ray beams (IMRT) still exit through healthy tissue. That physical difference only matters if it changes cure or late harm enough to justify the cost, which randomised adult trials have not settled.

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.