Departments of1Neurosurgery and.
2Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
J Neurosurg Spine. 2024 Jun 7;41(3):428-435. doi: 10.3171/2024.4.SPINE2491. Print 2024 Sep 1.
Spinal chordoma treatment guidelines recommend resection. However, in patients in whom gross-total resection (GTR) is achieved, the benefits of radiation therapy (RT) are unclear. Therefore, the authors performed a systematic review to determine if RT is associated with postoperative progression-free survival (PFS) or overall survival (OS) after achieving GTR of spinal chordoma.
The PubMed database was searched for studies including individualized data of patients undergoing GTR with or without RT for spinal chordoma. Patients < 18 years of age or those who underwent stereotactic body RT were excluded. Qualitative assessment was performed using Newcastle-Ottawa Scale guidelines. Log-rank tests for time-to-event data and a Cox proportional-hazards model were generated for a multivariable statistical model.
Complete data of 132 patients were retrieved, with 37 (28%) patients receiving adjuvant RT and 95 (72%) not receiving adjuvant RT. The mean follow-up was not statistically significantly different between those undergoing RT and not undergoing RT (54.02 months and 65.43 months, respectively). Patients were more likely not to undergo RT if their disease was located in the sacrum versus the mobile spine (p < 0.001). When controlling for age ≥ 65 years, male sex, disease location, and treatment year ≥ 2010, patients undergoing RT had similar PFS and OS when compared with those not undergoing RT on multivariable survival analysis (HR 0.935 [95% CI 0.703-2.340], p = 0.844 and HR 2.078 [95% CI 0.848-5.090], p = 0.110, respectively). However, age ≥ 65 years was associated with poorer OS in adjusted analyses (HR 2.761 [95% CI 1.185-6.432], p = 0.018) relative to patients < 65 years of age.
After achieving GTR of spinal chordoma, the utility of RT on PFS and OS remains unclear. Age ≥ 65 years appears to be associated with OS in spinal chordoma patients. Additional multicenter prospective studies are needed to determine the utility of RT in this patient population.
脊髓脊索瘤的治疗指南建议进行切除术。然而，在实现肿瘤大体全切（GTR）的患者中，放疗（RT）的获益尚不清楚。因此，作者进行了一项系统评价，以确定在实现脊髓脊索瘤 GTR 后，RT 是否与术后无进展生存期（PFS）或总生存期（OS）相关。
在 PubMed 数据库中搜索了纳入接受 GTR 联合或不联合 RT 治疗脊髓脊索瘤的患者个体数据的研究。排除年龄<18 岁或接受立体定向体部 RT 的患者。使用纽卡斯尔-渥太华量表指南进行定性评估。对数秩检验用于时间事件数据，Cox 比例风险模型用于多变量统计模型。
共检索到 132 例患者的完整数据，其中 37 例（28%）患者接受辅助 RT，95 例（72%）患者未接受辅助 RT。接受 RT 和未接受 RT 的患者的平均随访时间无统计学差异（分别为 54.02 个月和 65.43 个月）。如果疾病位于骶骨而不是活动脊柱，患者更不可能接受 RT（p<0.001）。在校正年龄≥65 岁、男性、疾病部位和治疗年份≥2010 年后，多变量生存分析显示，接受 RT 的患者与未接受 RT 的患者的 PFS 和 OS 相似（HR 0.935[95%CI 0.703-2.340]，p=0.844 和 HR 2.078[95%CI 0.848-5.090]，p=0.110）。然而，在校正分析中，年龄≥65 岁与较差的 OS 相关（HR 2.761[95%CI 1.185-6.432]，p=0.018），而年龄<65 岁的患者则无此相关性。
在实现脊髓脊索瘤 GTR 后，RT 对 PFS 和 OS 的作用尚不清楚。年龄≥65 岁似乎与脊髓脊索瘤患者的 OS 相关。需要进一步的多中心前瞻性研究来确定 RT 在该患者人群中的作用。
