R2 resection is as good as No surgery in terms of overall survival and DFS.

But the time interval from neurolgical free debility and /or symptom control and /or QOL may be better with debulking foll by Post op RT.

If your surgeon is offering it —-> i m sure he knows it why and for what :: seek his opinion as we do not have any surgeons in this isocentre.
Your surgeon would be able to quote the risks of this procedure.

As long as you are not desperate after second opinion from surgeons and pushing surgery for this patient yourslef, knowing what the
final outcome is and patient understands the risk and what R2 resection means.

amar

High dose Pall RT for symptom control is reasonable :- In view of young age, and if relatively good PS

Dose determined by what you think is safe :-

Organs at Risk: Brain Stem, Spinal Cord, Brain , Eyes, Pituitary etc

I hope you wont offer IMRT, but some simple 3DCRT.
(Understanding the limitation of newer technology and you ability to make a difference between radical doses and palliative doses)

PTV = 1.5 -2 cm margin
you may have to be tight at the spinal cord inferiorly

Max dose you can go for will be 48-50 Gy ( Spinal cord TD 5/5 ) - accepting a slightly higher risk.
We recently treated a Recurrent chordoma of the spine at D5-6 - we went upto 50 Gy, explaining the risk to the pt.

If you want to be more conservative and be safer settle for 46 Gy.

If you want chemo, in adjuvant setting —-

Single agent Doxorubicin gives response rates : 25-30%

Combination Chemo Doxorubicin + Ifosphamide : upto 40% response rate.

We usually go for the RT option first and then wait for him —-> to relapse locally or systemically

and then prefer to go for Palliative chemo option. (delayed chemo rather than offer them early).

Young pts go for combination
Older, less fit ones go for single agent.

Majority of pts fail / progress ( > 60%)

Second line chemo : Trabectidin (Yondelis) licensed for sarcomas

Cheers

Rohit