Santoro Andrea, Totti Riccardo, El Motassime Alessandro, Meschini Cesare, Di Costa Doriana, Gabrielli Elena, Maccauro Giulio, Vitiello Raffaele
Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito, 8, 00168 Rome, Italy.
Department of Orthopedics, Ageing and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS (Scientific Istitute for Research, Hospitalization and Healthcare), Largo Agostino Gemelli 8, 00168 Rome, Italy.
J Clin Med. 2025 Aug 22;14(17):5947. doi: 10.3390/jcm14175947.
: chordomas are characterized as locally aggressive yet infrequently metastasizing malignant neoplasms of bone, primarily arising in the axial skeleton, with a notable prevalence in the sacral region. En bloc resection is recognized as the standard treatment for sacral chordoma; however, its feasibility is not universally guaranteed. Therefore, definitive proton, carbon ion, or photon therapy is often utilized as an alternative to surgical intervention or as a (neo-)adjuvant measure in conjunction with surgery, owing to their role in enhancing local control. : a search of PubMed yielded 127 articles, with 18 that were ultimately included in the review. This review aims to systematically evaluate clinical outcomes and complications associated with hadron therapy in cases of sacral chordomas. The review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, including publication dates up to January 2025. : data extraction showed promising outcomes for patients treated with hadron therapy alone or when hadron therapy was used as an adjuvant for surgery, even if complications are described. The 5-year overall survival estimated from evaluating 10 of 18 articles was 82.4%, although some articles reported different results in shorter follow-up periods. Skin ulceration and pain were described in 323 (29%) and 186 (16%) patients, respectively. Chronic complications reported were sacral fractures, metastasis, rectal disorders, urinary disorders, and peripheral motor and sensory neuropathy. : hadron therapy represents a highly effective and promising treatment for sacral chordomas. In cases of inoperable tumors, it has demonstrated outcomes comparable to surgery while significantly reducing treatment-related morbidity. Hadron therapy is also viable as adjuvant therapy and provides superior outcomes for patients who undergo surgery with positive margins compared to those treated with surgery alone, improving local control and overall prognosis.
脊索瘤的特征是具有局部侵袭性但很少发生转移的骨恶性肿瘤，主要发生在中轴骨骼，在骶骨区域尤为常见。整块切除被认为是骶骨脊索瘤的标准治疗方法；然而，其可行性并非普遍得到保证。因此，由于其在增强局部控制方面的作用，确定性质子、碳离子或光子治疗通常被用作手术干预的替代方法或作为与手术联合的（新）辅助措施。：对PubMed的检索产生了127篇文章，其中18篇最终被纳入综述。本综述旨在系统评价强子治疗骶骨脊索瘤的临床疗效和并发症。该综述遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，包括截至2025年1月的发表日期。：数据提取显示，单独接受强子治疗或强子治疗作为手术辅助治疗的患者，即使描述了并发症，也有令人满意的结果。根据对18篇文章中的10篇进行评估得出的5年总生存率估计为82.4%，尽管一些文章在较短的随访期内报告了不同的结果。分别有323例（29%）和186例（16%）患者出现皮肤溃疡和疼痛。报告的慢性并发症包括骶骨骨折、转移、直肠疾病、泌尿系统疾病以及周围运动和感觉神经病变。：强子治疗是骶骨脊索瘤一种高效且有前景的治疗方法。对于无法手术切除的肿瘤，它已显示出与手术相当的疗效，同时显著降低了与治疗相关的发病率。强子治疗作为辅助治疗也是可行的，与单纯接受手术治疗的患者相比，对于手术切缘阳性的患者，它能提供更好的疗效，改善局部控制和总体预后。
