Historical development of the treatment of skull base tumours

Abstract

Surgery has evolved greatly over the last decades thanks to the more sophisticated and conservative surgical approaches and also thanks to the progress of diagnostic imaging. An added value is represented by the increased experience of the professionals and the close multidisciplinarity of the procedures including neurosurgeons, otolaryngologists and maxillo-facial surgeons. One of the most recent developments is the endoscopic surgery allowing for more conservative and cosmetically satisfactory outcomes. Radiation therapy has greatly changed over the last decades thanks to the technology advances related both to the availability of new imaging modalities and techniques of radiation delivery. Delivery of radiation evolved from three-dimensional conformal techniques to stereotactic and intensity-modulated radiation therapy. Particle therapy has the potential to further improve in the near future thanks to the progress of technology. Proton therapy allows for optimization of dose deposition in the target with lesser dose in the healthy tissues and ion therapy, currently using carbon ions, has been more recently introduced with the advantage of more effective treatments in case of less radio-sensitive tumours thanks to a higher biological effectiveness. A relevant concept that can significantly improve the results is that of interaction and integration of different disciplines not only within the surgical field. The cooperation between surgeons of various disciplines, radiation oncologists and medical oncologists together with professionals from other disciplines, such as pathology and radiology is nowadays required in an effort to customize and optimize the treatment in each single patient.

Keywords: History; Radiotherapy; Skull base; Surgery.

Fig. 1

Axial CT bone window of the skull base showing extent of bone removal using the translabyrinthine approach to the cerebello-pontine angle (yellow area).

Fig. 2

Chordoma treated with carbon ion radiotherapy at CNAO (Pavia, Italy) after endoscopic surgery. Carbon ions were delivered with active scanning and Intensity-Modulated Particle Therapy (IMPT) to a total dose of 70.4 Gy (RBE), 4.4 Gy (RBE)/fraction, in 16 daily fractions, 4 days a week.