Recent Advances in Proton Therapy for the Treatment of Skull Base Chordoma

Skull base chordoma is a rare, slow-growing primary tumor. Due to its proximity to the brainstem, blood vessels, and nerves, complete surgical resection is challenging. Therefore, postoperative radiotherapy is required to achieve full disease eradication. Compared to photon therapy, proton therapy offers physical dosimetric advantages, ensuring an adequate target dose while minimizing damage to surrounding tissues. Long-term follow-up has confirmed that proton therapy provides survival benefits and enhanced safety in treating skull base chordoma. Consequently, it is considered the standard radiotherapy approach for this condition. However, due to the low incidence of skull base chordoma and the high cost of proton therapy, only a limited number of prospective studies have evaluated its use in this disorder. To date, there is no consensus on proton therapy dosage, fractionation, or target delineation. In this review, we assess the latest advancements and challenges associated with proton therapy for chordomas located at the skull base, aiming to provide a comprehensive understanding of radiotherapy strategies for this disease.