A Review of Particle Therapy for Skull Base Tumors: Modern Considerations and Future Directions.

Eugen B Hug,Piero Fossati,Steven J Frank,Maciej Pelak

doi:10.14338/ijpt-20-00083

Abstract

Skull base tumors constitute one of the established indications for particle therapy, specifically proton therapy. However, a number of prognostic factors, practical clinical management issues, and the emerging role of carbon ion therapy remain subjects of active clinical investigation. This review summarizes these topics, assesses the present status, and reflects on future research directions focusing on the management of chordomas, one of the most aggressive skull base tumors. In addition, the role of particle therapy for benign tumors of the skull base, including pituitary adenoma and acoustic neuroma, is reviewed.

Highlights

Primary tumors of the skull base are rare overall
Both proton therapy and carbon ion radiation therapy have been successfully used in the treatment of skull base chordoma
Plan robustness must be considered in order to safely apply particle therapy in the skull base and the risk of overshooting into OARs or of underestimating the relative biological effectiveness of the distal high linear-energy transfer part of the particle beam must always be taken into consideration

Summary

Introduction

Primary tumors of the skull base are rare overall. if cancers of the head and neck region with secondary invasion of the skull base are included, for example, paranasal sinus cancers or primary intracranial tumors with location in the skull base (ie, meningiomas), the numbers rise, and familiarity with delivery of high-dose radiation to the skull base becomes a necessity for the practicing radiation oncologist.For many years, treatment of skull base tumors has been considered one of the established indications of particle therapy [1]. Treatment of skull base tumors has been considered one of the established indications of particle therapy [1]. If one accepts that particles are indicated for midsize tumors of the skull base with limited gross residual disease after an adequate surgical debulking or subtotal resection, the controversies are about the indications and efficacy of particle therapy at either side of the spectrum: (1) postoperatively for small or visibly gross totally resected disease and (2) for large unresectable disease with compression of such critical structures as optic chiasm and brainstem.

Results

Conclusion