Abstract
ObjectiveMalignant tumors that involve the skull base pose significant challenges to the clinician because of the proximity of critical neurovascular structures and limited effectiveness of surgical resection without major morbidity. The purpose of this study was to evaluate the efficacy and safety of multi-session radiosurgery in patients with malignancies of the skull base.MethodsClinical and radiographic data for 37 patients treated with image-guided, multi-session radiosurgery between January 2002 and December 2007 were reviewed retrospectively. Lesions were classified according to involvement with the bones of the base of the skull and proximity to the cranial nerves.ResultsOur cohort consisted of 37 patients. Six patients with follow-up periods less than four weeks were eliminated from statistical consideration, thus leaving the data from 31 patients to be analyzed. The median follow-up was 37 weeks. Ten patients (32%) were alive at the end of the follow-up period. At last follow-up, or the time of death from systemic disease, tumor regression or stable local disease was observed in 23 lesions, representing an overall tumor control rate of 74%. For the remainder of lesions, the median time to progression was 24 weeks. The median progression-free survival was 230 weeks. The median overall survival was 39 weeks. In the absence of tumor progression, there were no cranial nerve, brainstem or vascular complications referable specifically to CyberKnife® radiosurgery.ConclusionOur experience suggests that multi-session radiosurgery for the treatment of malignant skull base tumors is comparable to other radiosurgical techniques in progression-free survival, local tumor control, and adverse effects.
Highlights
A variety of malignant tumors can involve the skull base
We evaluated the efficacy and safety of staged stereotactic radiosurgery for treatment of malignant skull base tumors, either as a primary treatment modality or as an adjunct to surgery and conventional external beam radiotherapy
Patient Population We performed a retrospective review of 464 patients with intracranial tumors who were treated with CyberKnife® stereotactic radiosurgery (CKS) at Georgetown University Hospital between January 2002 and December 2007
Summary
A variety of malignant tumors can involve the skull base. These tumors may originate from various tissues of the skull base, or invade into the region as extensions of head and neck cancers [1,2]. Common clinical presentations include pain and cranial nerve deficits, such as visual disturbances, facial paresis and swallowing difficulties [3]. Treatment of these tumors presents formidable challenges to the clinician. Metastatic skull base tumors are often late complications of systemic cancers, and the advanced systemic tumor burden, poor overall clinical condition and the morbidities from prior interventions, all make treatment difficult [6,7]
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