Commentary

The authors present eight patients who underwent surgical treatment for petroclival region chordomas. Their approach to these complex patients incorporates many aspects critical to the treatment of chordomas: maximal surgical resection, use of a variety of skull base approaches tailored to the location of tumor, extensive resection of bone surrounding the soft tissue tumor component, and adjunctive radiation therapy. The authors used stereotactic radiosurgery (SRS) to treat residual and recurrent tumors. We prefer the use of proton beam therapy, which has the longest treatment record and highest success rate associated with the treatment of chordomas. SRS is more readily accessible than proton beam therapy, which would make treatment with this modality advantageous. However, a large series of patients treated with SRS would be required to ascertain the role of this modality in the management of chordomas.