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Fractionated radiotherapy after gross-total resection of spinal chordoma: a systematic review of survival outcomes using individualized patient data.
Gendreau, Julian L; Gowda, Kritika; Kazemi, Foad; Horowitz, Melanie; Shalom, Moshe; Kuo, Cathleen C; Mehkri, Yusuf; Yan, Michael; Redmond, Kristin J; Lubelski, Daniel; Mukherjee, Debraj.
Afiliación
  • Gendreau JL; Departments of1Neurosurgery and.
  • Gowda K; Departments of1Neurosurgery and.
  • Kazemi F; Departments of1Neurosurgery and.
  • Horowitz M; Departments of1Neurosurgery and.
  • Shalom M; 2Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
  • Kuo CC; 3Department of Neurosurgery, University of Buffalo School of Medicine, Buffalo, New York.
  • Mehkri Y; 4Department of Neurosurgery, University of Florida School of Medicine, Jacksonville, Florida; and.
  • Yan M; 5Department of Neurosurgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
  • Redmond KJ; 6Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland.
  • Lubelski D; Departments of1Neurosurgery and.
  • Mukherjee D; Departments of1Neurosurgery and.
J Neurosurg Spine ; : 1-8, 2024 Jun 07.
Article en En | MEDLINE | ID: mdl-38848586
ABSTRACT

OBJECTIVE:

Spinal chordoma treatment guidelines recommend resection. However, in patients in whom gross-total resection (GTR) is achieved, the benefits of radiation therapy (RT) are unclear. Therefore, the authors performed a systematic review to determine if RT is associated with postoperative progression-free survival (PFS) or overall survival (OS) after achieving GTR of spinal chordoma.

METHODS:

The PubMed database was searched for studies including individualized data of patients undergoing GTR with or without RT for spinal chordoma. Patients < 18 years of age or those who underwent stereotactic body RT were excluded. Qualitative assessment was performed using Newcastle-Ottawa Scale guidelines. Log-rank tests for time-to-event data and a Cox proportional-hazards model were generated for a multivariable statistical model.

RESULTS:

Complete data of 132 patients were retrieved, with 37 (28%) patients receiving adjuvant RT and 95 (72%) not receiving adjuvant RT. The mean follow-up was not statistically significantly different between those undergoing RT and not undergoing RT (54.02 months and 65.43 months, respectively). Patients were more likely not to undergo RT if their disease was located in the sacrum versus the mobile spine (p < 0.001). When controlling for age ≥ 65 years, male sex, disease location, and treatment year ≥ 2010, patients undergoing RT had similar PFS and OS when compared with those not undergoing RT on multivariable survival analysis (HR 0.935 [95% CI 0.703-2.340], p = 0.844 and HR 2.078 [95% CI 0.848-5.090], p = 0.110, respectively). However, age ≥ 65 years was associated with poorer OS in adjusted analyses (HR 2.761 [95% CI 1.185-6.432], p = 0.018) relative to patients < 65 years of age.

CONCLUSIONS:

After achieving GTR of spinal chordoma, the utility of RT on PFS and OS remains unclear. Age ≥ 65 years appears to be associated with OS in spinal chordoma patients. Additional multicenter prospective studies are needed to determine the utility of RT in this patient population.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: J Neurosurg Spine Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: J Neurosurg Spine Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article