Management of skull base chordoma

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.