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Radiotherapy, Radiosurgery, and Proton Beam

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Midline Skull Base Surgery

Abstract

Chordomas of the skull base are rare bone tumors with locally aggressive behavior. Surgery is the primary treatment of skull base chordomas, although long-term observation series have shown its limitation in achieving a complete removal of the lesion due to the critical location and the infiltrative patterns into the bone and neurovascular structures of the skull base.

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References

  1. Tai PT, Craighead P, Bagdon F (1995) Optimization of radiotherapy for patients with cranial chordoma. A review of dose-response ratios for photon techniques. Cancer 75:749–756

    Article  CAS  PubMed  Google Scholar 

  2. Khairi S, Ewend MG (2002) Chordoma. Curr Treat Options Neurol 4:167–173

    Article  PubMed  Google Scholar 

  3. Mendenhall WM, Mendenhall CM, Lewis SB et al (2005) Skull base chordoma. Head Neck 27:159–165

    Article  PubMed  Google Scholar 

  4. Romero J, Cardenes H, la Torre A et al (1993) Chordoma: results of radiation therapy in eighteen patients. Radiother Oncol 29:27–32

    Article  CAS  PubMed  Google Scholar 

  5. Catton C, O’Sullivan B, Bell R et al (1996) Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 41:67–72

    Article  CAS  PubMed  Google Scholar 

  6. Hug EB (2000) Proton radiation therapy for chordomas and chondrosarcomas of the skull base. Neurosurg Clin N Am 11:627–638

    CAS  PubMed  Google Scholar 

  7. Cummings BJ, Hodson DI, Bush RS (1983) Chordoma: the results of megavoltage radiation therapy. Int J Radiat Oncol Biol Phys 9:633–642

    Article  CAS  PubMed  Google Scholar 

  8. Chetiyawardana AD (1984) Chordoma: results of treatment. Clin Radiol 35:159–161

    Article  CAS  PubMed  Google Scholar 

  9. Amendola BE, Amendola MA, Oliver E et al (1986) Chordoma: role of radiation therapy. Radiology 158:839–843

    Article  CAS  PubMed  Google Scholar 

  10. Fuller DB, Bloom JG (1988) Radiotherapy for chordoma. Int J Radiat Oncol Biol Phys 15:331–339

    Article  CAS  PubMed  Google Scholar 

  11. Forsyth PA, Cascino TL, Shaw EG et al (1993) Intracranial chordomas: a clinicopathological and prognostic study of 51 cases. J Neurosurg 78:741–747

    Article  CAS  PubMed  Google Scholar 

  12. Watkins L, Khudados ES, Kaleoglu M et al (1993) Skull base chordomas: a review of 38 patients, 1958–88. Br J Neurosurg 7:241–248

    Article  CAS  PubMed  Google Scholar 

  13. Zorlu F, Gürkaynak M, Yildiz F et al (2000) Conventional external radiotherapy in the management of clivus chordomas with overt residual disease. Neurol Sci 21:203–207

    Article  CAS  PubMed  Google Scholar 

  14. Cho YH, Kim JH, Khang SK et al (2008) Chordomas and chondrosarcomas of the skull base: comparative analysis of clinical results in 30 patients. Neurosurg Rev 31:35–43

    Article  PubMed  Google Scholar 

  15. Sahgal A, Chan MW, Atenafu EG et al (2015) Image-guided intensity modulated radiation therapy (IG-IMRT) for skull base chordoma and chondrosarcoma: preliminary outcomes. Neuro Oncol 17(6):889–894

    Article  PubMed  Google Scholar 

  16. Debus J, Schulz-Ertner D, Schad L et al (2000) Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys 47:591–596

    Article  CAS  PubMed  Google Scholar 

  17. Bugoci DM, Girvigian MR, Chen JC et al (2013) Photon-based fractionated stereotactic radiotherapy for postoperative treatment of skull base chordomas. Am J Clin Oncol 36:404–410

    Article  CAS  PubMed  Google Scholar 

  18. Miller RC, Foote RL, Coffey RJ et al (1997) The role of stereotactic radiosurgery in the treatment of malignant skull base tumors. Int J Radiat Oncol Biol Phys 39:977–981

    Article  CAS  PubMed  Google Scholar 

  19. Muthukumar N, Kondziolka D, Lunsford LD et al (1998) Stereotactic radiosurgery for chordoma and chondrosarcoma: further experiences. Int J Radiat Oncol Biol Phys 41:387–392

    Article  CAS  PubMed  Google Scholar 

  20. Crockard A, Macaulay E, Plowman PN (1999) Stereotactic radiosurgery. VI. Posterior displacement of the brainstem facilitates safer high dose radiosurgery for clival chordoma. Br J Neurosurg 13:65–70

    Article  CAS  PubMed  Google Scholar 

  21. Chang SD, Martin DP, Lee E et al (2001) Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for residual or recurrent cranial base and cervical chordomas. Neurosurg Focus 10, E5

    Article  CAS  PubMed  Google Scholar 

  22. Gwak HS, Yoo HJ, Youn SM et al (2005) Hypofractionated stereotactic radiation therapy for skull base and upper cervical chordoma and chondrosarcoma: preliminary results. Stereotact Funct Neurosurg 83:233–243

    Article  PubMed  Google Scholar 

  23. Krishnan S, Foote RL, Brown PD et al (2005) Radiosurgery for cranial base chordomas and chondrosarcomas. Neurosurgery 56:777–784

    Article  PubMed  Google Scholar 

  24. Hasegawa T, Ishii D, Kida Y et al (2007) Gamma Knife surgery for skull base chordomas and chondrosarcomas. J Neurosurg 107:752–757

    Article  PubMed  Google Scholar 

  25. Martin JJ, Niranjan A, Kondziolka D et al (2007) Radiosurgery for chordomas and chondrosarcomas of the skull base. J Neurosurg 107:758–764

    Article  PubMed  Google Scholar 

  26. Liu AL, Wang ZC, Sun SB et al (2008) Gamma knife radiosurgery for residual skull base chordomas. Neurol Res 30:557–561

    Article  PubMed  Google Scholar 

  27. Ito E, Saito K, Okada T et al (2010) Long-term control of clival chordoma with initial aggressive surgical resection and gamma knife radiosurgery for recurrence. Acta Neurochir (Wien) 152:57–67

    Article  Google Scholar 

  28. Kano H, Iqbal FO, Sheehan J et al (2011) Stereotactic radiosurgery for chordoma: a report from the North American Gamma Knife Consortium. Neurosurgery 68:379–389

    Article  PubMed  Google Scholar 

  29. Dassoulas K, Schlesinger D, Yen CP et al (2009) The role of Gamma Knife surgery in the treatment of skull base chordomas. J Neurooncol 94:243–248

    Article  PubMed  Google Scholar 

  30. Kondziolka D, Lunsford LD, Flickinger JC (1991) The role of radiosurgery in the management of chordoma and chondrosarcoma of the cranial base. Neurosurgery 29:38–45

    Article  CAS  PubMed  Google Scholar 

  31. Henderson FC, McCool K, Seigle J et al (2009) Treatment of chordomas with CyberKnife: Georgetown University experience and treatment recommendations. Neurosurgery 64:A44–A53

    Article  PubMed  Google Scholar 

  32. Zorlu F, Gultekin M, Cengiz M et al (2014) Fractionated stereotactic radiosurgery treatment results for skull base chordomas. Technol Cancer Res Treat 13:11–19

    CAS  PubMed  Google Scholar 

  33. Benk V, Liebsch NJ, Munzenrider JE et al (1995) Base of skull and cervical spine chordomas in children treated by high-dose irradiation. Int J Radiat Oncol Biol Phys 31:577–581

    Article  CAS  PubMed  Google Scholar 

  34. Hug E, Loredo LN, Slater JD et al (1999) Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 91:432–439

    Article  CAS  PubMed  Google Scholar 

  35. Munzenrider JE, Liebsch NJ (1999) Proton therapy for tumors of the skull base. Strahlenther Onkol 175:57–63

    Article  PubMed  Google Scholar 

  36. Terahara A, Niemierko A, Goitein M et al (1999) Analysis of the relationship between tumor dose inhomogeneity and local control in patients with skull base chordoma. Int J Radiat Oncol Biol Phys 45:351–358

    Article  CAS  PubMed  Google Scholar 

  37. Hug EB, Sweeney RA, Nurre PM et al (2002) Proton radiotherapy in management of pediatric base of skull tumors. Int J Radiat Oncol Biol Phys 52:1017–1024

    Article  PubMed  Google Scholar 

  38. Igaki H, Tokuuye K, Okumura T et al (2004) Clinical results of proton beam therapy for skull base chordoma. Int J Radiat Oncol Biol Phys 60:1120–1126

    Article  PubMed  Google Scholar 

  39. Noël G, Feuvret L, Calagaru V et al (2005) Chordomas of the spine and upper cervical spine. One hundred patient irradiated by a 3D conformal technique combining photon and proton beams. Acta Oncol 44:700–708

    Article  PubMed  Google Scholar 

  40. Weber DC, Rutz HP, Pedroni ES et al (2005) Results of spot-scanning proton radiation therapy for chordoma and chondrosarcoma of the skull base: the Paul Scherrer institute experience. Int J Radiat Oncol Biol Phys 63:401–409

    Article  PubMed  Google Scholar 

  41. Rutz HP, Weber DC, Goitein G et al (2008) Postoperative spot-scanning proton radiation therapy for chordoma and chondrosarcoma in children and adolescents: initial experience at Paul Scherrer Institute. Int J Radiat Oncol Biol Phys 71:220–225

    Article  PubMed  Google Scholar 

  42. Ares C, Hug EB, Lomax AJ et al (2009) Effectiveness and safety of spot scanning proton radiation therapy for chordomas and chondrosarcomas of the skull base: first long-term report. Int J Radiat Oncol Biol Phys 75:1111–1118

    Article  PubMed  Google Scholar 

  43. Fuji H, Nakasu Y, Ishida Y et al (2011) Feasibility of proton beam therapy for chordoma and chondrosarcoma of the skull base. Skull Base 21:201–206

    Article  PubMed Central  PubMed  Google Scholar 

  44. Yasuda M, Bresson D, Chibbaro S et al (2012) Chordomas of the skull base and cervical spine: clinical outcomes associated with a multimodal surgical resection combined with proton-beam radiation in 40 patients. Neurosurg Rev 35:171–183

    Article  PubMed  Google Scholar 

  45. Rombi B, Ares C, Hug EB et al (2013) Spot-scanning proton radiation therapy for pediatric chordoma and chondrosarcoma: clinical outcome of 26 patients treated at Paul Scherrer Institute. Int J Radiat Oncol Biol Phys 86:578–584

    Article  PubMed  Google Scholar 

  46. Deraniyagala RL, Yeung D, Mendenhall WM et al (2014) Proton therapy for skull base chordomas: an outcome study from the university of Florida proton therapy institute. J Neurol Surg B Skull Base 75:53–57

    Article  PubMed Central  PubMed  Google Scholar 

  47. Grosshans DR, Zhu XR, Melancon A et al (2014) Spot scanning proton therapy for malignancies of the base of skull: treatment planning, acute toxicities, and preliminary clinical outcomes. Int J Radiat Oncol Biol Phys 90:540–546

    Article  PubMed  Google Scholar 

  48. McDonald MW, Linton OR, Shah MV (2013) Proton therapy for reirradiation of progressive or recurrent chordoma. Int J Radiat Oncol Biol Phys 87:1107–1114

    Article  PubMed  Google Scholar 

  49. Austin-Seymour M, Munzenrider J, Goitein M et al (1989) Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull. J Neurosurg 70:13–17

    Article  CAS  PubMed  Google Scholar 

  50. Al-Mefty O, Borba LA (1997) Skull base chordomas: a management challenge. J Neurosurg 86:182–189

    Article  CAS  PubMed  Google Scholar 

  51. Pai HH, Thornton A, Katznelson L et al (2001) Hypothalamic/pituitary function following high-dose conformal radiotherapy to the base of skull: demonstration of a dose-effect relationship using dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 49:1079–1092

    Article  CAS  PubMed  Google Scholar 

  52. Santoni R, Liebsch N, Finkelstein DM et al (1998) Temporal lobe (TL) damage following surgery and high-dose photon and proton irradiation in 96 patients affected by chordomas and chondrosarcomas of the base of the skull. Int J Radiat Oncol Biol Phys 41:59–68

    Article  CAS  PubMed  Google Scholar 

  53. Colli B, Al-Mefty O (2001) Chordomas of the skull base: follow-up review and prognostic factors. Neurosurg Focus 10:111

    Article  Google Scholar 

  54. Slater JM (1995) Proton therapy for cranial base tumors. J Craniofac Surg 6:24–26

    Article  CAS  PubMed  Google Scholar 

  55. Debus J, Hug EB, Liebsch NJ et al (1997) Brainstem tolerance to conformal radiotherapy of skull base tumors. Int J Radiat Oncol Biol Phys 39:967–975

    Article  CAS  PubMed  Google Scholar 

  56. Tsujii H, Mizoe J, Kamada T et al (2007) Clinical results of carbon ion radiotherapy at NIRS. J Radiat Res 48 Suppl. 2:A1–A13

    Article  Google Scholar 

  57. Mizoe JE, Hasegawa A, Takagi R et al (2009) Carbon ion radiotherapy for skull base chordoma. Skull Base 19:219–224

    Article  PubMed Central  PubMed  Google Scholar 

  58. Takahashi S, Kawase T, Yoshida K et al (2009) Skull base chordomas: efficacy of surgery followed by carbon ion radiotherapy. Acta Neurochir (Wien) 151:759–769

    Article  Google Scholar 

  59. Nikoghosyan AV, Karapanagiotou-Schenkel I, Münter MW et al (2010) Randomised trial of proton vs. carbon ion radiation therapy in patients with chordoma of the skull base, clinical phase III study HIT-1-Study. BMC Cancer 10:607

    Article  PubMed Central  PubMed  Google Scholar 

  60. Tsujii H, Kamada T (2012) A review of update clinical results of carbon ion radiotherapy. Jpn J Clin Oncol 42:670–685

    Article  PubMed Central  PubMed  Google Scholar 

  61. Uhl M, Mattke M, Welzel T et al (2014) Highly effective treatment of skull base chordoma with carbon ion irradiation using a raster scan technique in 155 patients: first long-term results. Cancer 120:3410–3417

    Article  CAS  PubMed  Google Scholar 

  62. Schulz-Ertner D, Karger CP, Feuerhake A et al (2007) Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas. Int J Radiat Oncol Biol Phys 68:449–457

    Article  PubMed  Google Scholar 

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Correspondence to Giuseppe Minniti MD .

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Minniti, G., Scaringi, C. (2016). Radiotherapy, Radiosurgery, and Proton Beam. In: Cappabianca, P., Cavallo, L., de Divitiis, O., Esposito, F. (eds) Midline Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-21533-4_28

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  • DOI: https://doi.org/10.1007/978-3-319-21533-4_28

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21532-7

  • Online ISBN: 978-3-319-21533-4

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