Radiation therapy strategies for skull-base malignancies
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TOPIC REVIEW
Radiation therapy strategies for skull‑base malignancies J. D. Palmer1,2 · M. E. Gamez1 · K. Ranta1 · H. Ruiz‑Garcia3 · J. L. Peterson3,4 · D. M. Blakaj1 · D. Prevedello2,5 · R. Carrau2,5 · A. Mahajan6 · K. L. Chaichana4 · D. M. Trifiletti3,4 Received: 13 April 2020 / Accepted: 22 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction The management of skull base malignancies continues to evolve with improvements in surgical technique, advances in radiation delivery and novel systemic agents. Methods In this review, we aim to discuss in detail the management of common skull base pathologies which typically require multimodality therapy, focusing on the radiotherapeutic aspects of care. Results Technological advances in the administration of radiation therapy have led to a wide variety of different treatment strategies for the treatment of skull base malignances, with outcomes summarized herein. Conclusion Radiation treatment plays a key and critical role in the management of patients with skull base tumors. Recent advancements continue to improve the risk/benefit ratio for radiotherapy in this setting. Keywords Skull base · Radiation · Intensity modulated radiation therapy · Proton therapy · Stereotactic radiosurgery · Gamma knife radiosurgery · Intensity modulated proton therapy Abbreviations EOR Extent of resection GTR Gross total resection NTR Near total resection STR Subtotal resection PR Partial resection J. D. Palmer and M. E. Gamez co-first author contributing equally to the published work. * D. M. Trifiletti [email protected] 1
Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
2
Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
3
Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
4
Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
5
Department of Otolaryngology – Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
6
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
PFS Progression free survival OS Overall survival LC Local control LRFS Local recurrence free survival TSS Tumor specific survival yo Years old NS Not specified (N)SBM (Non-) skull base meningioma ChS Chondrosarcoma ChD Chordoma DI Diabetes insipidus QOL Quality of life ADL Activity of daily living RR Retrospective review SR Systematic review RT Radiation therapy (h)FSRT (Hypo)fractionated stereotactic radiosurgery SRS Stereotactic radiosurgery GKRT Gamma-knife radiation therapy IMRT Intensity modulated radiation therapy
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Introduction Tumors of the skull base represent a heterogeneous spectrum of entities, histologically, biologically and pathogenically distinct, that develop within or grow into the skull base, graded under
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