title: Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement.
abstract: OBJECTIVE
  Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity.
  
  
  METHODS
  A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed.
  
  
  RESULTS
  Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months.
  
  
  CONCLUSIONS
  The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting.
authors.affiliation: Department of Radiotherapy and Radiation Oncology, University Hospital of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
authors.forename: L H
authors.initials: LH
authors.lastname: Dröge
authors.forename: T
authors.initials: T
authors.lastname: Hinsche
authors.forename: M
authors.initials: M
authors.lastname: Canis
authors.forename: B
authors.initials: B
authors.lastname: Alt-Epping
authors.forename: C F
authors.initials: CF
authors.lastname: Hess
authors.forename: H A
authors.initials: HA
authors.lastname: Wolff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003391:Cranial Nerves / Q000473:pathology* / Q000528:radiation effects; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009460:Neurologic Examination / Q000528:radiation effects; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D019292:Skull Base Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D016896:Treatment Outcome