Myneni Saket, Ahmed A Karim, Kazemi Foad, Saraswathula Anirudh, Zwagerman Nathan T, Su Shirley Y, Choby Garret, Wang Eric W, Van Gompel Jamie J, Redmond Kristin J, McKean Erin L, Snyderman Carl H, Gardner Paul A, Rowan Nicholas R, Mukherjee Debraj
Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
Department of Otolaryngology- Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.
J Neurooncol. 2025 May 22. doi: 10.1007/s11060-025-05088-9.
Current treatment for skull base chordomas utilizes both surgical resection and adjuvant radiation, but recent studies have demonstrated evidence that has brought the use of adjuvant radiotherapy into question. Chordomas differ greatly in molecular makeup and proliferation. These factors have led to significant variation in management across providers. We used a modified Delphi approach to work towards consensus on standardized operative definitions and evidence-based management of chordomas.
Our multidisciplinary panel included participants representing the AANS/CNS Tumor Section and North American Skull Base Society (NASBS) with a track record of publishing on chordoma management. Our approach involved a four-step process: one statement-generation round, two voting rounds to establish consensus and refine statements, and a final external validation round by NASBS members. Anonymous voting was completed via Qualtrics surveys.
The statement-generation process produced 65 statements. Through the Delphi process, 36 statements reached consensus during the first round and an additional 17 were refined for further consensus in the second round. Moderate (67-80%) or strong (> 80%) consensus was achieved for 43 final statements. Forty-one items were externally validated. There was consensus that an endoscopic endonasal approach should be utilized whenever possible. They defined the tumor characteristics (molecular and cytogenic) to consider before offering adjuvant radiotherapy.
This modified Delphi study generated consensus on 41 statements regarding skull base chordoma management. These statements aim to shed light on the consensus among providers regarding the use of surgery, neoadjuvant radiation, adjuvant radiation, adjuvant systemic therapies, and treatment of recurrence for chordoma.
目前颅底脊索瘤的治疗采用手术切除和辅助放疗，但最近的研究表明，辅助放疗的使用受到了质疑。脊索瘤在分子组成和增殖方面差异很大。这些因素导致不同医疗服务提供者的治疗方法存在显著差异。我们采用改良的德尔菲法，以就脊索瘤的标准化手术定义和循证管理达成共识。
我们的多学科小组包括代表美国神经外科医师协会/中枢神经系统肿瘤学组和北美颅底学会（NASBS）的参与者，他们在脊索瘤治疗方面有发表文章的记录。我们的方法包括四个步骤：一轮陈述生成、两轮投票以达成共识并完善陈述，以及由NASBS成员进行的最后一轮外部验证。通过Qualtrics调查完成匿名投票。
陈述生成过程产生了65条陈述。通过德尔菲法，第一轮有36条陈述达成共识，第二轮又有17条陈述得到完善以达成进一步共识。43条最终陈述达成了中度（67%-80%）或强烈（>80%）共识。41项内容得到了外部验证。达成的共识是，应尽可能采用内镜鼻内入路。他们定义了在提供辅助放疗之前应考虑的肿瘤特征（分子和细胞遗传学）。
这项改良的德尔菲研究就41条关于颅底脊索瘤治疗的陈述达成了共识。这些陈述旨在阐明医疗服务提供者在脊索瘤手术、新辅助放疗、辅助放疗、辅助全身治疗以及复发治疗的使用方面的共识。
