Rodrigues Amanda Cyntia Lima Fonseca, Tos Salem M, Shaaban Ahmed, Mantziaris Georgios, Trifiletti Daniel M, Sheehan Jason
Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
Neurosurg Rev. 2024 Dec 7;47(1):893. doi: 10.1007/s10143-024-03117-1.
Chordomas are rare, locally aggressive tumors that have a high rate of recurrence, especially at the skull base. This systematic review and meta-analysis aimed to analyze the efficacy and safety of proton beam therapy (PBT) and carbon ion radiotherapy (CIRT) for skull base chordoma. We conducted a systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science, and Ovid up to November 26, 2023, following the PRISMA statement. Studies involving more than 10 patients with skull base chordoma treated with PBT or CIRT were included. The outcomes analyzed were local control, overall survival, progression-free survival, and toxicities. Meta-analysis was performed using the Mantel-Haenszel method and the inverse variance method. Fourteen studies met the inclusion criteria, encompassing 1,145 patients (671 treated with PBT and 474 with CIRT). No significant difference was found between PBT and CIRT for 5-year local control (LC) and overall survival (OS). The only timepoint with a difference in local control was at 3 years, when PBT showed an advantage in local control (90% vs. 83% for CIRT; p = 0.05) and progression-free survival was similar (94% for PBT vs. 83% for CIRT; p = 0.09). Sensitivity analysis and meta-regression revealed no significant influence of predefined parameters on outcomes. Publication bias was suggested by asymmetrical funnel plots. Both PBT and CIRT are effective treatments for skull base chordoma, with comparable long-term efficacy. This meta-analysis underscores the need for individualized treatment approaches and further research to refine these therapies in clinical practice.
脊索瘤是一种罕见的、具有局部侵袭性的肿瘤，复发率很高，尤其是在颅底。本系统评价和荟萃分析旨在分析质子束治疗（PBT）和碳离子放疗（CIRT）治疗颅底脊索瘤的疗效和安全性。我们按照PRISMA声明，对截至2023年11月26日的MEDLINE、EMBASE、CENTRAL、Web of Science和Ovid进行了系统检索。纳入了涉及10例以上接受PBT或CIRT治疗的颅底脊索瘤患者的研究。分析的结局包括局部控制、总生存、无进展生存和毒性。使用Mantel-Haenszel法和逆方差法进行荟萃分析。14项研究符合纳入标准，共纳入1145例患者（671例接受PBT治疗，474例接受CIRT治疗）。PBT和CIRT在5年局部控制（LC）和总生存（OS）方面未发现显著差异。局部控制存在差异的唯一时间点是3年时，此时PBT在局部控制方面显示出优势（CIRT为83%，PBT为9%；p = 0.05），无进展生存相似（PBT为94%，CIRT为83%；p = 0.09）。敏感性分析和荟萃回归显示，预定义参数对结局无显著影响。不对称漏斗图提示存在发表偏倚。PBT和CIRT都是治疗颅底脊索瘤的有效方法，长期疗效相当。这项荟萃分析强调了在临床实践中需要个体化治疗方法并进一步开展研究以优化这些治疗。
