Saito Takashi, Mizumoto Masashi, Oshiro Yoshiko, Shimizu Shosei, Li Yinuo, Nakamura Masatoshi, Hosaka Sho, Nakai Kei, Iizumi Takashi, Inaba Masako, Fukushima Hiroko, Suzuki Ryoko, Maruo Kazushi, Sakurai Hideyuki
Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan.
Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba 305-8558, Ibaraki, Japan.
Cancers (Basel). 2024 Jul 17;16(14):2569. doi: 10.3390/cancers16142569.
[Objective] The aim of this study was to compare the efficacy of particle beam therapy (PT) with photon radiotherapy (RT) for treatment of skull base chordoma. [Methods] A systematic review was conducted for skull base chordoma treated with PT or photon RT reported from 1990 to 2022. Data were extracted for overall survival (OS) and progression-free survival (PFS), late adverse events, age, gender, gross total resection (GTR) rates, tumor volume, total irradiation dose, and treatment modality. Random-effects meta-regression analysis with the treatment modality as an explanatory variable was performed for each outcome to compare the modalities. [Results] A meta-analysis of 30 selected articles found 3- and 5-year OS rates for PT vs. photon RT or combined photon RT/proton beam therapy (PBT) of 90.8% (95% CI: 87.4-93.3%) vs. 89.5% (95% CI: 83.0-93.6%), = 0.6543; 80.0% (95% CI: 75.7-83.6%) vs. 89.5% (95% CI: 83.0-93.6%), = 0.6787. The 5-year PFS rates for PT vs. photon RT or photon RT/PBT were 67.8% (95% CI: 56.5-76.7%) vs. 40.2% (95% CI: 31.6-48.7%), = 0.0004. A random-effects model revealed that the treatment modality (PT vs. photon RT or photon RT/PBT) was not a significant factor for 3-year OS ( = 0.42) and 5-year OS ( = 0.11), but was a significant factor for 5-year PFS ( < 0.0001). The rates of brain necrosis were 8-50% after PT and 0-4% after photon RT or photon RT/PBT. [Conclusion] This study shows that PT results in higher PFS compared to photon RT for skull base chordoma, but that there is a tendency for a higher incidence of brain necrosis with PT. Publication and analysis of further studies is needed to validate these findings.
[目的] 本研究旨在比较粒子束治疗（PT）与光子放射治疗（RT）治疗颅底脊索瘤的疗效。[方法] 对1990年至2022年报道的采用PT或光子RT治疗的颅底脊索瘤进行系统评价。提取总生存期（OS）、无进展生存期（PFS）、晚期不良事件、年龄、性别、大体全切（GTR）率、肿瘤体积、总照射剂量和治疗方式等数据。以治疗方式为解释变量，对每个结局进行随机效应Meta回归分析以比较不同治疗方式。[结果] 对30篇入选文章的Meta分析发现，PT与光子RT或联合光子RT/质子束治疗（PBT）相比，3年和5年OS率分别为90.8%（95%CI：87.4 - 93.3%）对89.5%（95%CI：83.0 - 93.6%），P = 0.6543；80.0%（95%CI：75.7 - 83.6%）对89.5%（95%CI：83.0 - 93.6%），P = 0.6787。PT与光子RT或光子RT/PBT相比，5年PFS率分别为67.8%（95%CI：56.5 - 76.7%）对40.2%（95%CI：31.6 - 48.7%），P = 0.0004。随机效应模型显示，治疗方式（PT与光子RT或光子RT/PBT）对3年OS（P = 0.42）和5年OS（P = 0.11）不是显著因素，但对5年PFS是显著因素（P < 0.0001）。PT后脑坏死发生率为8% - 50%，光子RT或光子RT/PBT后为0% - 4%。[结论] 本研究表明，对于颅底脊索瘤，PT与光子RT相比可带来更高的PFS，但PT有导致更高脑坏死发生率的趋势。需要进一步研究的发表和分析来验证这些发现。
