Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA.
J Neurooncol. 2020 May;147(3):503-513. doi: 10.1007/s11060-020-03464-1. Epub 2020 Mar 23.
Carbon ion radiotherapy (CIRT) is an emerging radiation therapy to treat skull base chordomas and chondrosarcomas. To date, its use is limited to a few centers around the world, and there has been no attempt to systematically evaluate survival and toxicity outcomes reported in the literature. Correspondingly, the aim of this study was to qualitatively and quantitatively assess these outcomes.
A systematic search of seven electronic databases from inception to November 2019 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes were then pooled by random-effects meta-analyses of proportions.
A total of nine studies provided unique metadata for assessment, with six originating from Heidelberg, Germany. The surveyed cohort size was 632 patients, with 389 (62%) chordomas and 243 (38%) chondrosarcomas of the skull base. Across all studies, median cohort age at therapy and female proportion were 46 years and 51% respectively. Estimates of local control incidence at 1-, 5-, and 10-years in chordoma-only studies were 99%, 80%, and 56%, and in chondrosarcoma-only studies were 99%, 89%, and 88%. Estimates of overall survival probability at 1-, 5-, and 10-years in chordoma-only studies were 100%, 94%, and 78%, and in chondrosarcoma-only studies were 99%, 95%, and 79%. The incidence of early and late toxicity (Grade ≥ 3) ranged from 0 to 4% across all study groups.
The emerging use of CIRT to treat skull base chordomas and chondrosarcomas appear promising with regard to tumor control, overall survival, and risk profile of early and late toxicity. The current literature suffers from the fact only a few centers in the world currently employ this technology.
碳离子放疗（CIRT）是一种新兴的放射治疗方法，用于治疗颅底脊索瘤和软骨肉瘤。迄今为止，它的应用仅限于世界上的少数几个中心，而且尚未尝试系统地评估文献中报告的生存和毒性结果。相应地，本研究的目的是定性和定量评估这些结果。
根据 PRISMA 指南，对从成立到 2019 年 11 月的七个电子数据库进行了系统搜索。文章根据预先指定的标准进行筛选。然后通过随机效应荟萃分析对比例进行汇总。
共有 9 项研究提供了可评估的独特元数据，其中 6 项来自德国海德堡。调查的队列规模为 632 例患者，其中 389 例（62%）为颅底脊索瘤，243 例（38%）为软骨肉瘤。在所有研究中，队列的中位治疗年龄和女性比例分别为 46 岁和 51%。仅在脊索瘤研究中，1 年、5 年和 10 年的局部控制发生率估计值分别为 99%、80%和 56%，而仅在软骨肉瘤研究中分别为 99%、89%和 88%。仅在脊索瘤研究中，1 年、5 年和 10 年的总生存率估计值分别为 100%、94%和 78%，而仅在软骨肉瘤研究中分别为 99%、95%和 79%。所有研究组的早期和晚期毒性（≥3 级）发生率均为 0 至 4%。
用 CIRT 治疗颅底脊索瘤和软骨肉瘤的新兴应用在肿瘤控制、总体生存率以及早期和晚期毒性的风险特征方面似乎很有前景。目前的文献存在一个事实，即世界上只有少数几个中心目前采用这种技术。
