Proton beam therapy in the management of skull base chordomas: systematic review of indications, outcomes, and implications for neurosurgeons

Matloob, Samir A; Nasir, Haleema A; Choi, David

doi:10.1080/02688697.2016.1181154

Cited by 29 publications

(19 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Particularly in lesions with extension lateral to the ICAs, this goal of total resection may require a variety of surgical approaches and multimodality treatment. Although the relative rarity of skull‐base chordomas is at least in part responsible for a lack of high‐quality prospective trials, there is a general consensus that adjuvant radiation may play a role in disease control . In contrast, the role of adjuvant chemotherapy and immunotherapy are largely undefined and not routinely used.…”

Section: Clival Tumorsmentioning

confidence: 99%

“…Conventional external beam RT was used among several patients in the analyses included, but other radiation modalities were adopted more frequently, including IMRT, stereotactic radiosurgery, and proton beam therapy. In general, proton beam RT is employed when critical unaffected structures are located directly adjacent to tumors . Importantly, there is a pronounced dose decrease beyond targeted tissue, which minimizes damage to surrounding critical skull‐base structures including the brainstem and CN VI.…”

Section: Clival Tumorsmentioning

confidence: 99%

“…Among series in which specific radiation modality was detailed, a plurality (46.5%) of patients underwent adjuvant proton beam RT. A recent systematic review has suggested that proton beam therapy likely has higher local control and survival than other radiation modalities for clival chordomas, although trials with direct comparison are needed to further solidify this into a consensus . The primary disadvantages of proton beam therapy include a lack of availability and cost.…”

Section: Clival Tumorsmentioning

confidence: 99%

See 2 more Smart Citations

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

View full text Add to dashboard Cite

Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

show abstract

Section: Clival Tumorsmentioning

confidence: 99%

Section: Clival Tumorsmentioning

confidence: 99%

Section: Clival Tumorsmentioning

confidence: 99%

See 1 more Smart Citation

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

View full text Add to dashboard Cite

show abstract

“…In a very recent study assessing proton therapy in combination with surgical resection for skull base chordomas, the reported 5- and 7-year local control rates were 75.8% and 70.9%, respectively 64 . Another systematic review also concluded that proton therapy improves long-term local control and survival in patients with skull base chordoma 65 . In tumors of the sacrum and spine, surgical resection coupled with proton therapy provided a 5-year overall survival and local control rate of 81% and 62%, respectively 66 .…”

Section: Treatmentmentioning

confidence: 99%

Recent advances in understanding and managing chordomas

et al. 2016

View full text Add to dashboard Cite

Chordomas are rare primary bone tumors arising from embryonic remnants of the notochord. They are slow-growing, locally aggressive, and destructive and typically involve the axial skeleton. Genetic studies have identified several mutations implicated in the pathogenesis of these tumors. Treatment poses a challenge given their insidious progression, degree of local invasion at presentation, and high recurrence rate. They tend to respond poorly to conventional chemotherapy and radiation. This makes radical resection the mainstay of their treatment. Recent advances in targeted chemotherapy and focused particle beam radiation, however, have improved the management and prognosis of these tumors.

show abstract

“…Unlike photon radiotherapy, which can deposit high radiation doses in normal tissues in an attempt to cover the target, PBT has the ability to spare these same normal tissues and decrease the integral dose because the dose is deposited as per the "Bragg Peak" to a specified depth, with a very rapid dose fall-off thereafter. This may lead to a significant decrease in radiation-related toxicity and the ability to dose escalate, which has been associated with improved outcomes in certain tumor sites [2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%