Chordoma Family Study
Condition: Chordoma
MeSH terms: Chordoma
Study type: Observational

Summary: 
      This pilot study, conducted by the National Cancer Institute and the Massachusetts General
      Hospital, will investigate genetic factors that contribute to the development of chordoma in
      people from some families. Chordoma is a very rare, potentially fatal, slow-growing bone
      tumor derived from remnants of embryonic material. This study will determine the feasibility
      of conducting a larger study aimed at identifying new families with multiple members affected
      by chordoma to study the genetic basis of the disease.

      English-speaking persons diagnosed with chordoma when they were 18 years of age or younger
      and who were treated at the Massachusetts General Hospital Department of Radiation Oncology
      between 1988 and the end of the study period may be eligible for this protocol. The age range
      of these patients is currently from about 5 months to 33 years.

      Patients (or parents of minor patients) will be mailed a packet with instructions for
      completing the following procedures at home:

        -  Provide permission for researchers to obtain medical records relating to the patient's
           chordoma and any other serious medical conditions he or she has had, and to obtain a
           piece of the patient's stored tumor tissue.

        -  Complete a questionnaire about the patient's close blood relatives, including parents,
           brothers, sisters, and any more distant relatives who have had chordoma or a cancer or
           tumor which started in the brain or spine. The questionnaire will also include
           demographic information, such as education, marital status, ethnicity, religion, and
           household income.

        -  Collect two samples of cheek cells (only from patients 6 years and older). Patients'
           packets include instructions and materials for collecting the cells. Parents of children
           6 to 9 years old will collect cells from the child's mouth using a sterile soft-bristled
           brush contained in a tube. They will brush the inside of the child's cheek with the
           brush for about 30 seconds and then place the brush back in the tube. They will repeat
           this procedure with a second brush. Patients 10 years of age and older will rinse their
           mouth for about 45 seconds with a mouthwash provided in their packets and then spit the
           mouthwash into a collection container. They will repeat the procedure several hours
           later.

      All participants will return the signed permission forms, questionnaires, and cheek cell
      samples to the researchers in a pre-addressed stamped envelope, which is also provided in the
      packet.

      ...
    

Detailed description: 
      Chordoma is a rare, slow growing, potentially fatal bone tumor derived from remnants of
      vestigial or ectopic notochord. It occurs almost exclusively in the axial skeleton (skull
      base, vertebrae, sacrum and coccyx), is somewhat more frequent in males than females, and has
      a median age at diagnosis of 58.5 years, with a range from early childhood to over 70 years.
      This typically sporadic tumor usually presents at an advanced stage and the associated
      mortality is high due to local destruction or distant metastases.

      Recently, we identified several families with chordoma in multiple relatives in a pattern
      consistent with transmission of an autosomal dominant trait. Using clinical and genotyping
      information from three such families, we mapped a familial chordoma gene to chromosome 7q33.
      Now, we need to identify more multiplex chordoma families to participate in studies to fine
      map and clone this gene. To do this, we established collaboration with Dr. Norbert Liebsch,
      Department of Radiation Oncology (DRO), Massachusetts General Hospital (MGH), Boston. Since
      1975, this department has treated ~500 patients with chordoma of the skull base or cervical
      spine from all over the world; about 400 of these patients speak English.

      The proposed study is a pilot study based on up to 80 English-speaking MGH chordoma patients
      diagnosed age 18 years for whom Dr. Liebsch is the physician of record. We chose this group
      because of Dr. Liebsch's personal knowledge of the patients and the fact that young age at
      diagnosis may indicate increased genetic susceptibility to chordoma. A major purpose of the
      pilot study is to determine the feasibility of conducting a larger study encompassing the
      remaining (~320) English-speaking MGH chordoma patients. The major goal of the full study
      would be to identify new multiplex chordoma families to participate in clinical and gene
      mapping studies.

      The data collection components of the pilot study include 1) a family medical history
      questionnaire completed by each patient/parent or next of kin in person or over the
      telephone, 2) collecting buccal cells from each patient ~ age 6 years via a mailed buccal
      cell collection kit, 3) abstracting information about each patient's past medical history
      from the DRO/MGH medical records, and 4) obtaining paraffin blocks or slides on each
      chordoma/other primary cancer from the MGH Pathology Department or relevant outside
      institutions. DNA from buccal cells and tumor will be used for molecular studies.

      We will re-contact any family from the pilot study who reports chordoma or astrocytoma in at
      least one blood relative of the MGH patient. If we confirm these diagnoses we will invite
      selected family members to participate in clinical and gene mapping studies conducted under a
      separate NIH approved protocol. We will consider the pilot study to be a success if up to 30-
      35 of the 80 chordoma patients/parents/next of kin participate in it, OR if we identify a new
      multiplex chordoma family that is willing to participate in clinical and gene mapping
      studies.
    

Observational model: Family-Based
Time perspective: Retrospective
Keywords: Gene; Genetics; Family History; Radiation Therapy; Children