Skull base chordomas review of current treatment paradigms

Background: Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation. Methods: Literature review of current treatment strategies fo...

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Autores principales:	Dan Yaniv, Ethan Soudry, Yulia Strenov, Marc A. Cohen, Aviram Mizrachi
Formato:	article
Lenguaje:	EN
Publicado:	KeAi Communications Co., Ltd. 2020
Materias:	Skull Base Chordoma Surgery Review Targeted therapy Otorhinolaryngology RF1-547 RD1-811
Acceso en línea:	https://doaj.org/article/8ed2510c6aac44029cb926bf0dc63fcf
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spelling	oai:doaj.org-article:8ed2510c6aac44029cb926bf0dc63fcf2021-12-02T15:56:17ZSkull base chordomas review of current treatment paradigms2095-881110.1016/j.wjorl.2020.01.008https://doaj.org/article/8ed2510c6aac44029cb926bf0dc63fcf2020-06-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2095881120300317https://doaj.org/toc/2095-8811Background: Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation. Methods: Literature review of current treatment strategies for chordomas of the skull base. Results: Surgery is the mainstay of treatment and complete resection has paramount importance for prognosis.When complete resection is not achieved recurrent disease is common. The anatomical complexity of the skull base makes resection complex. Endonasal endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be challenging.Evidence suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the disease. Nonetheless, immediate post-operative radiotherapy improves survival. Many strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy, gamma knife surgery, proton beam therapy, and carbon ion radiation therapy.There is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show promise. Several optional molecular targets exist. Brachyury is overexpressed in 95% of chordomas but not in other mesenchymal neoplasms. However, its precise role in chordoma pathogenesis is currently unclear, and its cellular location in the nucleus makes it difficult to target. The inhibition of brachyury in chordoma cell lines induces growth arrest and apoptosis. This does not have clinical application to date. There are retrospective results with different molecular targeted therapies for advanced chordomas with some effectiveness. Conclusion: Despite improvements made in the past 10 years in our knowledge of chordoma biology, available therapies still offer a limited benefit. There is an unmet need for new therapeutic options for patients with advanced disease. Therefore, patients with advanced disease should be encouraged to participate in clinical trials when and where available.Dan YanivEthan SoudryYulia StrenovMarc A. CohenAviram MizrachiKeAi Communications Co., Ltd.articleSkull BaseChordomaSurgeryReviewTargeted therapyOtorhinolaryngologyRF1-547SurgeryRD1-811ENWorld Journal of Otorhinolaryngology-Head and Neck Surgery, Vol 6, Iss 2, Pp 125-131 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Skull Base Chordoma Surgery Review Targeted therapy Otorhinolaryngology RF1-547 Surgery RD1-811
spellingShingle	Skull Base Chordoma Surgery Review Targeted therapy Otorhinolaryngology RF1-547 Surgery RD1-811 Dan Yaniv Ethan Soudry Yulia Strenov Marc A. Cohen Aviram Mizrachi Skull base chordomas review of current treatment paradigms
description	Background: Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation. Methods: Literature review of current treatment strategies for chordomas of the skull base. Results: Surgery is the mainstay of treatment and complete resection has paramount importance for prognosis.When complete resection is not achieved recurrent disease is common. The anatomical complexity of the skull base makes resection complex. Endonasal endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be challenging.Evidence suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the disease. Nonetheless, immediate post-operative radiotherapy improves survival. Many strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy, gamma knife surgery, proton beam therapy, and carbon ion radiation therapy.There is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show promise. Several optional molecular targets exist. Brachyury is overexpressed in 95% of chordomas but not in other mesenchymal neoplasms. However, its precise role in chordoma pathogenesis is currently unclear, and its cellular location in the nucleus makes it difficult to target. The inhibition of brachyury in chordoma cell lines induces growth arrest and apoptosis. This does not have clinical application to date. There are retrospective results with different molecular targeted therapies for advanced chordomas with some effectiveness. Conclusion: Despite improvements made in the past 10 years in our knowledge of chordoma biology, available therapies still offer a limited benefit. There is an unmet need for new therapeutic options for patients with advanced disease. Therefore, patients with advanced disease should be encouraged to participate in clinical trials when and where available.
format	article
author	Dan Yaniv Ethan Soudry Yulia Strenov Marc A. Cohen Aviram Mizrachi
author_facet	Dan Yaniv Ethan Soudry Yulia Strenov Marc A. Cohen Aviram Mizrachi
author_sort	Dan Yaniv
title	Skull base chordomas review of current treatment paradigms
title_short	Skull base chordomas review of current treatment paradigms
title_full	Skull base chordomas review of current treatment paradigms
title_fullStr	Skull base chordomas review of current treatment paradigms
title_full_unstemmed	Skull base chordomas review of current treatment paradigms
title_sort	skull base chordomas review of current treatment paradigms
publisher	KeAi Communications Co., Ltd.
publishDate	2020
url	https://doaj.org/article/8ed2510c6aac44029cb926bf0dc63fcf
work_keys_str_mv	AT danyaniv skullbasechordomasreviewofcurrenttreatmentparadigms AT ethansoudry skullbasechordomasreviewofcurrenttreatmentparadigms AT yuliastrenov skullbasechordomasreviewofcurrenttreatmentparadigms AT marcacohen skullbasechordomasreviewofcurrenttreatmentparadigms AT avirammizrachi skullbasechordomasreviewofcurrenttreatmentparadigms
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Skull base chordomas review of current treatment paradigms

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