[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.
【目的】本研究旨在比较粒子束治疗（PT）与光子放疗（RT）治疗颅底脊索瘤的疗效。【方法】对1990年至2022年间报道的采用PT或光子RT治疗的颅底脊索瘤进行系统性综述。提取总生存期（OS）、无进展生存期（PFS）、晚期不良事件、年龄、性别、肿瘤全切率、肿瘤体积、总照射剂量及治疗模式等数据。以治疗模式为解释变量，对各结局指标进行随机效应元回归分析以比较不同治疗模式。【结果】对30篇入选文献的荟萃分析显示，PT与光子RT或光子RT/质子束治疗（PBT）联合疗法的3年及5年OS率分别为：90.8%（95% CI：87.4–93.3%）对比89.5%（95% CI：83.0–93.6%），p=0.6543；80.0%（95% CI：75.7–83.6%）对比89.5%（95% CI：83.0–93.6%），p=0.6787。PT与光子RT或光子RT/PBT的5年PFS率分别为67.8%（95% CI：56.5–76.7%）对比40.2%（95% CI：31.6–48.7%），p=0.0004。随机效应模型显示，治疗模式（PT对比光子RT或光子RT/PBT）对3年OS（p=0.42）和5年OS（p=0.11）均非显著影响因素，但对5年PFS具有显著影响（p<0.0001）。PT治疗后脑坏死发生率为8–50%，而光子RT或光子RT/PBT治疗后为0–4%。【结论】本研究表明，对于颅底脊索瘤，PT相较于光子RT可获得更高的PFS，但PT治疗后脑坏死的发生率存在升高趋势。需通过进一步研究的发表与分析来验证这些发现。
肿瘤(癌症)患者之家