Fractionated photon radiation therapy for skull base chordomas and chondrosarcomas

Chordomas and chondrosarcomas of the base of the skull are difficult to manage because of their location and proximity to critical structures. Since recurrence after surgery alone is common, planning of multimodal therapy, including postoperative radiation, is often essential. Although postoperative radiation improves local control of tumor after surgery, its efficacy may be limited by proximity of critical structures such as the brainstem and optic pathways. Significant improvement in photon irradiation techniques, such as intensity-modulated radiation therapy, three-dimensional conformal radiation therapy, and tomotherapy, are permitting delivery of higher dose to tumor while sparing critical normal structures from radiation exposure above tolerable levels.