Prevention and management of complications after radiotherapy for skull base tumors: a multidisciplinary approach

Radiotherapy is an important treatment approach for a variety of benign and malignant skull base tumors. For patients with malignant skull base tumors, radiation therapy is usually given with surgery and chemotherapy. While patient- and tumor-specific factors can affect the risk of radiation-related complications, surgery and chemotherapy also play a large causal role. As surgery and chemotherapy can lower the radiation dose tolerance of the normal tissues in the skull base, a multidisciplinary team approach is necessary in the initial treatment decision-making process. Radiation can delay wound healing and increase complications after reconstructive surgery, and so surgical planning between surgeons and radiation oncologists is critical to ensure the successful repair. In this article, we will discuss the etiology, risk factors and management of osteonecrosis and sinonasal-cutaneous fistula, the two major complications after multimodality treatment of skull base tumors. Careful consideration of specific tumor-, patient- and treatment-related factors in a multidisciplinary manner is vital in minimizing these complications.