Surgical resection followed by brachytherapy for malignancies involving the base of the skull.

Between January 1990 and July 1991, 14 patients were referred to the University of Pittsburgh for cranial base surgery following diagnosis of end-stage primary or recurrent neoplasms of the base of the skull. The treatment approach consisted of resection of the tumor along with placement of afterloading nylon catheters for iridium-192 implantation in areas where remaining tumor was believed to be present. A median dose of 3600 cGy (range, 2500 to 6000) was delivered to the tumor bed 1 to 14 days following surgery. with a median follow-up of 9 months, three patients remain alive without disease at 18, 19 and 36 months, and two are alive with disease at 5 and 31 months. Six patients died of disease at 3, 3, 3, 7, 16, and 17 months and three patients died of intercurrent disease at 1, 5, and 11 months. Cranial base surgery followed by brachytherapy appears to be a viable alternative in patients who otherwise have exhausted other methods of treatment. Careful attention to preoperative evaluation, surgery, and postoperative recovery should be given in order to prevent major complications.