Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Neurosurgery. 2023 Aug 1;93(2):257-266. doi: 10.1227/neu.0000000000002418. Epub 2023 Feb 24.
Current treatment guidelines for clival chordomas recommend surgical resection followed by high-dose radiotherapy (RT). However, in patients in whom gross total resection (GTR) is achieved, the benefits of additional RT remain unclear.
To investigate whether RT offers any benefit to progression-free survival (PFS) in patients undergoing GTR of clival chordoma by performing a systematic review of all currently published literature.
A total of 5 databases were searched to include all studies providing data on GTR ± RT for clival chordomas (January 1990-June 2021). Qualitative assessment was performed with Newcastle-Ottawa Scale guidelines for assessing quality of nonrandomized studies. Statistical analysis using individualized patient data of PFS was performed.
The systematic search yielded 2979 studies, weaned to 22 full-text articles containing 108 patients. All patients underwent GTR of clival chordoma, with 46 (43%) patients receiving adjuvant RT. Mean PFS for RT patients was 31.09 months (IQR: 12.25-37.75) vs 54.92 months (IQR: 14.00-85.75) in non-RT patients. Overall, RT did not increase PFS (HR 0.320, P = .069) to a value that achieved statistical significance. Stratifying by photon therapy vs particle beam therapy yielded no statistically significant benefit for particle beam therapy for PFS ( P = .300). Of patients with age ≥65 years, RT did not improve outcomes to statistical significance for PFS (HR 0.450, P = .481). Patients age ≥65 years had lower PFS on both bivariate analysis (HR 3.708, P = .007) and multivariate analysis (HR 3.322, P = .018).
After achieving GTR of clival chordoma, fractionated RT offers unclear benefit upon survival outcomes.
目前针对颅底脊索瘤的治疗指南建议行手术切除，随后行大剂量放疗（RT）。然而，在实现大体全切除（GTR）的患者中，额外 RT 的获益尚不清楚。
通过对所有已发表文献进行系统回顾，探讨在颅底脊索瘤行 GTR 的患者中，RT 是否能改善无进展生存期（PFS）。
共检索了 5 个数据库，纳入了所有提供 GTR ± RT 治疗颅底脊索瘤数据的研究（1990 年 1 月至 2021 年 6 月）。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）对非随机研究进行质量评估。对 PFS 的个体患者数据进行统计学分析。
系统检索共得到 2979 篇研究，筛选出 22 篇全文，其中包含 108 例患者。所有患者均行 GTR 治疗颅底脊索瘤，46 例（43%）患者接受辅助 RT。接受 RT 的患者中位 PFS 为 31.09 个月（IQR：12.25-37.75），未接受 RT 的患者中位 PFS 为 54.92 个月（IQR：14.00-85.75）。总体而言，RT 并未显著改善 PFS（HR 0.320，P =.069）。光子放疗与粒子束放疗亚组分析也未显示出粒子束放疗对 PFS 的显著获益（P =.300）。对于年龄≥65 岁的患者，RT 也未能显著改善 PFS（HR 0.450，P =.481）。在单因素和多因素分析中，年龄≥65 岁的患者 PFS 均更差（HR 3.708，P =.007；HR 3.322，P =.018）。
在实现颅底脊索瘤 GTR 后，分次 RT 对生存结局的获益并不明确。
