Proton versus photon adjuvant radiotherapy: a multicenter comparative evaluation of recurrence following spinal chordoma resection

Author:

Ghaith Abdul Karim12,Nguyen Ryan12,El-Hajj Victor Gabriel12,Montaser Alaa3,De Biase Gaetano3,Ravindran Krishnan3,Perez-Vega Carlos3,Lee Seung Jin3,Dominari Asmina12,Battistin Umberto12,Suárez-Meade Paola3,Moussalem Charbel2,Patel Naresh P.4,Kalani Maziyar A.4,Clarke Michelle J.2,Rose Peter S.2,Bydon Mohamad12,Abode-Iyamah Kingsley3,Akinduro Oluwaseun O.3

Affiliation:

1. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;

2. Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;

3. Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida; and

4. Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona

Abstract

OBJECTIVE Chordomas are rare tumors of the skull base and spine believed to arise from the vestiges of the embryonic notochord. These tumors are locally aggressive and frequently recur following resection and adjuvant radiotherapy. Proton therapy has been introduced as a tissue-sparing option because of the higher level of precision that proton-beam techniques offer compared with traditional photon radiotherapy. This study aimed to compare recurrence in patients with chordomas receiving proton versus photon radiotherapy following resection by applying tree-based machine learning models. METHODS The clinical records of all patients treated with resection followed by adjuvant proton or photon radiotherapy for chordoma at Mayo Clinic were reviewed. Patient demographics, type of surgery and radiotherapy, tumor recurrence, and other variables were extracted. Decision tree classifiers were trained and tested to predict long-term recurrence based on unseen data using an 80/20 split. RESULTS Fifty-three patients with a mean ± SD age of 55.2 ± 13.4 years receiving surgery and adjuvant proton or photon therapy to treat chordoma were identified; most patients were male. Gross-total resection was achieved in 54.7% of cases. Proton therapy was the most common adjuvant radiotherapy (84.9%), followed by conventional or external-beam radiation therapy (9.4%) and stereotactic radiosurgery (5.7%). Patients receiving proton therapy exhibited a 40% likelihood of having recurrence, significantly lower than the 88% likelihood observed in those treated with nonproton therapy. This was confirmed on logistic regression analysis adjusted for extent of tumor resection and tumor location, which revealed that proton adjuvant radiotherapy was associated with a decreased risk of recurrence (OR 0.1, 95% CI 0.01–0.71; p = 0.047) compared with photon therapy. The decision tree algorithm predicted recurrence with an accuracy of 90% (95% CI 55.5%–99.8%), with the lowest risk of recurrence observed in patients receiving gross-total resection with adjuvant proton therapy (23%). CONCLUSIONS Following resection, adjuvant proton therapy was associated with a lower risk of chordoma recurrence compared with photon therapy. The described machine learning models were able to predict tumor progression based on the extent of tumor resection and adjuvant radiotherapy modality used.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Reference24 articles.

1. Descriptive epidemiology of chordomas in the United States;Das P,2020

2. Chordoma: current concepts, management, and future directions;Walcott BP,2012

3. Surgical management of spinal chordoma: a systematic review and single-center experience;Baig Mirza A,2021

4. Chordoma: demographics and survival analysis with a focus on racial disparities and the role of surgery, a U.S. population-based study;Ullah A,2024

5. Efficacy and safety of carbon ion radiotherapy for chordomas: a systematic review and meta-analysis;Dong M,2023

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