Systematic Review and Meta-Analysis of Particle Beam Therapy versus Photon Radiotherapy for Skull Base Chordoma: TRP-Chordoma 2024

Author:

Saito Takashi1ORCID,Mizumoto Masashi1ORCID,Oshiro Yoshiko2,Shimizu Shosei3ORCID,Li Yinuo1ORCID,Nakamura Masatoshi1,Hosaka Sho4ORCID,Nakai Kei1ORCID,Iizumi Takashi1,Inaba Masako4,Fukushima Hiroko45,Suzuki Ryoko45,Maruo Kazushi6ORCID,Sakurai Hideyuki1

Affiliation:

1. Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan

2. Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba 305-8558, Ibaraki, Japan

3. Department of Pediatric Radiation Therapy Center/Pediatric Proton Beam Therapy Center, Hebei Yizhou Cancer Hospital, Zhuozhou 072750, China

4. Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8575, Ibaraki, Japan

5. Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan

6. Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan

Abstract

[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%), p = 0.6543; 80.0% (95% CI: 75.7–83.6%) vs. 89.5% (95% CI: 83.0–93.6%), p = 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%), p = 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 (p = 0.42) and 5-year OS (p = 0.11), but was a significant factor for 5-year PFS (p < 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.

Funder

Tsukuba University

Publisher

MDPI AG

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