Abstract
Two management modalities appear to be important in treating skull base chordomas: surgery and radiation therapy. Radical resection of lesions of the distal sacrum (S3–S5) and coccyx may be curative, as total removal is often achieved. In contrast, complete resection of chordomas of the base of the skull is rarely successful because of the inability to achieve a true complete surgical resection. On the other hand, treatment of skull base chordomas by radiation therapy alone is often difficult owing to the large size of the lesion and the dose limitation imposed by the sensitivity of the adjacent structures. Local relapse is the predominant type of treatment failure of skull base chordoma. Skull base surgery and radiation therapy have significantly improved over the last 20 years. The following papers review the most significant recent analyses of therapeutic options in treating skull base chordomas. It seems that the combination of aggressive surgery followed by combined proton-photon radiation therapy offers the best chance of longterm local control to patients harboring cranial chordomas.
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Papers reviewed
Al-Mefty O, Borba LAB (1997) Skull base chordomas: a management challenge. J Neurosurg 86:182–189
Gay E, Sekhar LN, Rubinstein E, et al (1995) Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 36:887–897
Fagundes MA, Hug EB, Liebsch NJ, et al (1995) Radiation therapy for chordomas of the base of the skull and cervical spine: patterns of failure and outcome after relapse. Int J Radiat Oncol Biol Phys 33:579–584
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O’Connel JX, Renard LG, Liebsch NJ, et al (1994) Base of skull chordoma. Cancer 74:2261–2267
Forsyth P, Cascino TL, Shaw EG, et al (1993) Intracranial chordomas: a clinicopathological and prognostic study of 51 cases. J Neurosurg 78:741–747
Austin-Seymour M, Munzenrider J, Goiten M, et al (1989) Fractionated proton radiation therapy of chordoma and lowgrade chondrosarcoma of the base of the skull. J Neurosurg 70:13–17
Further reading
Kondziolka D, Lunsford D, Flickinger JC (1991) The role of radiosurgery in the management of chordoma and chondrosarcoma of the cranial base. Neurosurgery 29:38–46
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Ammirati, M., Bernardo, A. Management of skull base chordoma. Crit Rev Neurosurg 9, 63–69 (1999). https://doi.org/10.1007/s003290050112
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DOI: https://doi.org/10.1007/s003290050112