Protons versus photons for the treatment of chordoma

Published on Jul 1, 2021in Cochrane Database of Systematic Reviews9.289
· DOI :10.1002/14651858.CD013224.PUB2
Iman El Sayed10
Estimated H-index: 10
(Alexandria University),
Daniel M. Trifiletti21
Estimated H-index: 21
(Mayo Clinic)
+ 2 AuthorsSunil W Dutta1
Estimated H-index: 1
(Emory University)
BACKGROUND Chordoma is a rare primary bone tumour with a high propensity for local recurrence. Surgical resection is the mainstay of treatment, but complete resection is often morbid due to tumour location. Similarly, the dose of radiotherapy (RT) that surrounding healthy organs can tolerate is frequently below that required to provide effective tumour control. Therefore, clinicians have investigated different radiation delivery techniques, often in combination with surgery, aimed to improve the therapeutic ratio. OBJECTIVES To assess the effects and toxicity of proton and photon adjuvant radiotherapy (RT) in people with biopsy-confirmed chordoma. SEARCH METHODS We searched CENTRAL (2021, Issue 4); MEDLINE Ovid (1946 to April 2021); Embase Ovid (1980 to April 2021) and online registers of clinical trials, and abstracts of scientific meetings up until April 2021. SELECTION CRITERIA We included adults with pathologically confirmed primary chordoma, who were irradiated with curative intent, with protons or photons in the form of fractionated RT, SRS (stereotactic radiosurgery), SBRT (stereotactic body radiotherapy), or IMRT (intensity modulated radiation therapy). We limited analysis to studies that included outcomes of participants treated with both protons and photons. DATA COLLECTION AND ANALYSIS The primary outcomes were local control, mortality, recurrence, and treatment-related toxicity. We followed current standard Cochrane methodological procedures for data extraction, management, and analysis. We used the ROBINS-I tool to assess risk of bias, and GRADE to assess the certainty of the evidence. MAIN RESULTS We included six observational studies with 187 adult participants. We judged all studies to be at high risk of bias. Four studies were included in meta-analysis. We are uncertain if proton compared to photon therapy worsens or has no effect on local control (hazard ratio (HR) 5.34, 95% confidence interval (CI) 0.66 to 43.43; 2 observational studies, 39 participants; very low-certainty evidence). Median survival time ranged between 45.5 months and 66 months. We are uncertain if proton compared to photon therapy reduces or has no effect on mortality (HR 0.44, 95% CI 0.13 to 1.57; 4 observational studies, 65 participants; very low-certainty evidence). Median recurrence-free survival ranged between 3 and 10 years. We are uncertain whether proton compared to photon therapy reduces or has no effect on recurrence (HR 0.34, 95% CI 0.10 to 1.17; 4 observational studies, 94 participants; very low-certainty evidence). One study assessed treatment-related toxicity and reported that four participants on proton therapy developed radiation-induced necrosis in the temporal bone, radiation-induced damage to the brainstem, and chronic mastoiditis; one participant on photon therapy developed hearing loss, worsening of the seventh cranial nerve paresis, and ulcerative keratitis (risk ratio (RR) 1.28, 95% CI 0.17 to 9.86; 1 observational study, 33 participants; very low-certainty evidence). There is no evidence that protons led to reduced toxicity. There is very low-certainty evidence to show an advantage for proton therapy in comparison to photon therapy with respect to local control, mortality, recurrence, and treatment related toxicity. AUTHORS' CONCLUSIONS There is a lack of published evidence to confirm a clinical difference in effect with either proton or photon therapy for the treatment of chordoma. As radiation techniques evolve, multi-institutional data should be collected prospectively and published, to help identify persons that would most benefit from the available radiation treatment techniques.
📖 Papers frequently viewed together
#1Abolfazl Rahimizadeh (IUMS: Iran University of Medical Sciences)H-Index: 11
#2Nima Mohsenikabir (IUMS: Iran University of Medical Sciences)H-Index: 2
Last. Naser Asgari (IUMS: Iran University of Medical Sciences)H-Index: 4
view all 3 authors...
Background: Iatrogenic lumbar pseudomeningoceles are an uncommon complication of lumbar spinal surgeries. This pathology is an extradural, encapsulated, and cerebrospinal fluid collection which develops as a consequence of an inadvertent, unrepaired dural tear. If a pseudomeningocele grows beyond 8 cm in length, it may be classified as "giant. Case Description: Two adult females with giant pseudomeningoceles due to remote lumbar laminectomy were presented. Both patients were surgically managed. ...
#1Sunil W. Dutta (UVA: University of Virginia)H-Index: 10
#2Iman El Sayed (Alexandria University)H-Index: 10
Last. Daniel M. Trifiletti (Mayo Clinic)H-Index: 21
view all 7 authors...
#1E.R. GatfieldH-Index: 1
#2D.J. Noble (University of Cambridge)H-Index: 7
Last. Neil G. Burnet (University of Cambridge)H-Index: 51
view all 8 authors...
Abstract Aims To evaluate the long-term outcomes of patients with chordoma and low-grade chondrosarcoma after surgery and high-dose radiotherapy. Materials and methods High-dose photon radiotherapy was delivered to 28 patients at the Neuro-oncology Unit at Addenbrooke's Hospital (Cambridge, UK) between 1996 and 2016. Twenty-four patients were treated with curative intent, 17 with chordoma, seven with low-grade chondrosarcoma, with a median dose of 65 Gy (range 65–70 Gy). Local control and surviv...
#1Max Jägersberg (University of Geneva)H-Index: 9
#2Amir El Rahal (University of Geneva)H-Index: 5
Last. Karl Lothard Schaller (University of Geneva)H-Index: 45
view all 6 authors...
Background The treatment of clival chordomas remains challenging. Total tumour resection is often impossible without hampering adjacent anatomical structures and causing functional sequelae. On the other hand, chordomas show limited response to non-surgical treatment modalities. Up to now, no well-established interdisciplinary treatment algorithms for clival chordomas exist. In this regard, we analysed the data from all patients that underwent interdisciplinary treatment for clival chordoma in o...
#6Meera Viswanathan (RTP: Research Triangle Park)H-Index: 30
Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (indivi...
#1Damien C. Weber (University of Bern)H-Index: 58
#2Robert Malyapa (Paul Scherrer Institute)H-Index: 4
Last. Ralf Schneider (Paul Scherrer Institute)H-Index: 15
view all 10 authors...
Abstract Purpose To evaluate the long term tumor control and toxicity of skull base tumors treated with pencil beam scanning proton therapy (PT). Materials and methods PT was delivered to 151 (68%) and 71 (32%) chordoma and chondrosarcoma (ChSa) patients, respectively. Mean age of patients was 40.8±18.4years and the male to female ratio was 0.53. The postoperative tumor was abutting the brainstem or optic apparatus in 71 (32.0%) patients. The postoperative mean gross tumor volume (GTV) was 35.7±...
#1Martin Hasselblatt (WWU: University of Münster)H-Index: 57
#2Christian Thomas (WWU: University of Münster)H-Index: 15
Last. Marcel Kool (DKFZ: German Cancer Research Center)H-Index: 93
view all 30 authors...
#1Ronny L. RotondoH-Index: 12
#2Wendy FolkertH-Index: 1
Last. Thomas F. DeLaneyH-Index: 74
view all 12 authors...
OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. RESULTS Seventy-one sacrococcyg...
#1Arjun Sahgal (U of T: University of Toronto)H-Index: 68
#2Michael Chan (U of T: University of Toronto)H-Index: 6
Last. Normand Laperriere (U of T: University of Toronto)H-Index: 51
view all 16 authors...
Skull base chondrosarcoma arises from endochondral bone in the cerebellopontine angle, paranasal sinuses, parasellar area, and clivus. Chordoma arises from ectopic notochord remnants, and approximately a third are within the skull base.1 Although both tumors are generally indolent and considered low grade, they are locally destructive, invasive, and fatal if not properly managed. The focus of this report is on skull base chordoma and chondrosarcoma. Surgery is the first line of therapy, with the...
: Chordoma and chondrosarcoma represent 2 fundamentally different and challenging central skull base pathologies. Both are largely surgical diseases with varying outcomes based on completeness of resection. Adjuvant therapy is controversial, although radiation therapy is commonly employed postoperatively, and stereotactic radiosurgery is used either in primary management or treatment of local progression.
Cited By1
#1Sera TortH-Index: 1
#2Jane BurchH-Index: 6
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.