脊索瘤是極少見的惡性腫瘤。大多數脊索瘤發生在顱底、頸椎及薦骨。我們報告一少見原發腰椎的脊索瘤。此病例中，腰椎術後及放射線照射兩年後，沒有局部再發產生，卻轉移到右肩胛骨及左股骨幹。脊索瘤之治療仍是一個很大的挑戰。我們回顧文獻中有關脊索瘤之臨床表現、病態生理、治療策略及預後，並整理放射治療之最新進展，包括質子治療及重粒子治療如碳離子對脊索瘤之治療比較。

Chordomas are rare malignant neoplasms. Most chordomas are found at skull base, sacrum and cervical spine. We present a rare case of chordoma with lumbar spine origin and bone metastasis after operation and radiotherapy. In this case, no local recurrence was found in two years after tumor removal and adjuvant radiotherapy, but metastases to right scapula and left femur shaft were found afterward. Besides, the treatment of chordomas remains a challenge. We review the literatures of the clinical feature, pathophysiology, treatment modalities and prognosis of chordomas, and also the newest advances of radiotherapy, including proton beam radiotherapy (RT) and heavy charged particles RT (carbon ions) for treating chordomas.