Exploring perspectives on skull base chordoma management: a modified Delphi approach to consensus

Area of Science:

• Neurosurgery
• Oncology
• Skull Base Surgery

Background:

• Skull base chordomas require multimodal treatment, typically surgery and radiation.
• Recent evidence questions the routine use of adjuvant radiotherapy.
• Tumor heterogeneity necessitates standardized management guidelines.

Purpose of the Study:

• To achieve consensus on operative definitions and evidence-based management of skull base chordomas.
• To address variations in chordoma treatment protocols among providers.

Main Methods:

• A modified Delphi approach was employed with a multidisciplinary panel.
• The process included statement generation, multiple voting rounds, and external validation.
• Anonymous voting was conducted via Qualtrics surveys.

Main Results:

• Consensus was reached on 43 statements after multiple rounds.
• Forty-one statements were externally validated.
• Key agreements include prioritizing endoscopic endonasal approaches and defining criteria for adjuvant radiotherapy based on tumor characteristics.

Conclusions:

• The study generated consensus on 41 statements for skull base chordoma management.
• These guidelines cover surgical strategies, neoadjuvant and adjuvant radiotherapy, systemic therapies, and recurrence treatment.
• The findings aim to standardize care for skull base chordomas.