Abstract：
The objective of this retrospective study was to compare the survival of patients with biopsy-proven skull base chordoma who had undergone stereotactic radiosurgery (SRS) with versus without prior fractionated radiation therapy (RT).
Relevant articles from database inception to September 2021 were retrieved from the PubMed, Scopus, Web of Science, and Cochrane databases for a systematic review of treatment protocols. Studies were included if they 1) involved adult patients (age ≥ 18 years) with histologically and radiologically confirmed chordomas located within the clival skull base region and treated with SRS; 2) reported data on clinical features, SRS protocols, and outcomes; and 3) were written in the English language. Studies were excluded if they 1) were literature reviews, case reports, technical notes, abstracts, or autopsy reports; 2) did not clearly differentiate the data of patients with chordomas from the data of patients with different tumors or the data of patients with chordomas in locations other than the skull base; or 3) lacked histological confirmation or treatment and outcome data. Extracted data included the following: study author and publication year, patient age and sex, symptoms, cranial nerve involvement, invaded structures, lesion size, treatment modality, surgical details, histopathological type, RT modality, SRS parameters, complications, postradiosurgery outcomes, complications, and survival outcomes.
After the selection process, 15 articles describing 130 patients met the study eligibility criteria, including 94 patients who had undergone postresection SRS (NoRT group) and 36 who had undergone postresection fractionated RT and subsequent SRS (RT group). The NoRT and RT groups were comparable in age (51.3 vs 47.4 years, respectively), sex (57.1% vs 58.3% male), tumor volume (9.5 vs 11.2 cm3), SRS treatment parameters (maximum dose: 35.4 vs 42.2 Gy, marginal dose: 19.6 vs 20.6 Gy, treatment isodose line: 60.2% vs 65.2%), and SRS adverse effects (10.9% vs 17.6%). For the entire cohort, the 3-, 5-, and 10-year progression-free survival (PFS) rates were 23%, 9%, and 3%, respectively, and the overall survival (OS) rates were 94%, 82%, and 76%, respectively. In the NoRT group, SRS was adjuvant treatment after resection in 38 patients (40.4%), salvage treatment for recurrent tumor treated with resection alone in 10 (10.6%), and not specified in 46 (48.9%). In the RT group, SRS was boost treatment in 9 patients (25.0%), salvage treatment after recurrence in 22 (61.1%), and not specified in 5 (13.9%). There was no difference between the two groups in terms of median PFS (24.0 months [Q1 34.0, Q3 15.0] vs 23.8 months [34.0, 18.0], respectively; p = 0.8) or median OS (293.0 months [not reached, 137.4] vs not reached [not reached, 48.0], respectively; p = 0.36). The adverse radiation effect rates were comparable between the groups (10.9% vs 17.6%, respectively; p = 0.4).
The role of SRS in the management of skull base chordomas is still evolving. This systematic literature review of biopsy-proven chordoma revealed that tumor control and survival rates for SRS alone after chordoma surgery were not inferior to those encountered after SRS plus fractionated RT.
Relevant articles from database inception to September 2021 were retrieved from the PubMed, Scopus, Web of Science, and Cochrane databases for a systematic review of treatment protocols. Studies were included if they 1) involved adult patients (age ≥ 18 years) with histologically and radiologically confirmed chordomas located within the clival skull base region and treated with SRS; 2) reported data on clinical features, SRS protocols, and outcomes; and 3) were written in the English language. Studies were excluded if they 1) were literature reviews, case reports, technical notes, abstracts, or autopsy reports; 2) did not clearly differentiate the data of patients with chordomas from the data of patients with different tumors or the data of patients with chordomas in locations other than the skull base; or 3) lacked histological confirmation or treatment and outcome data. Extracted data included the following: study author and publication year, patient age and sex, symptoms, cranial nerve involvement, invaded structures, lesion size, treatment modality, surgical details, histopathological type, RT modality, SRS parameters, complications, postradiosurgery outcomes, complications, and survival outcomes.
After the selection process, 15 articles describing 130 patients met the study eligibility criteria, including 94 patients who had undergone postresection SRS (NoRT group) and 36 who had undergone postresection fractionated RT and subsequent SRS (RT group). The NoRT and RT groups were comparable in age (51.3 vs 47.4 years, respectively), sex (57.1% vs 58.3% male), tumor volume (9.5 vs 11.2 cm3), SRS treatment parameters (maximum dose: 35.4 vs 42.2 Gy, marginal dose: 19.6 vs 20.6 Gy, treatment isodose line: 60.2% vs 65.2%), and SRS adverse effects (10.9% vs 17.6%). For the entire cohort, the 3-, 5-, and 10-year progression-free survival (PFS) rates were 23%, 9%, and 3%, respectively, and the overall survival (OS) rates were 94%, 82%, and 76%, respectively. In the NoRT group, SRS was adjuvant treatment after resection in 38 patients (40.4%), salvage treatment for recurrent tumor treated with resection alone in 10 (10.6%), and not specified in 46 (48.9%). In the RT group, SRS was boost treatment in 9 patients (25.0%), salvage treatment after recurrence in 22 (61.1%), and not specified in 5 (13.9%). There was no difference between the two groups in terms of median PFS (24.0 months [Q1 34.0, Q3 15.0] vs 23.8 months [34.0, 18.0], respectively; p = 0.8) or median OS (293.0 months [not reached, 137.4] vs not reached [not reached, 48.0], respectively; p = 0.36). The adverse radiation effect rates were comparable between the groups (10.9% vs 17.6%, respectively; p = 0.4).
The role of SRS in the management of skull base chordomas is still evolving. This systematic literature review of biopsy-proven chordoma revealed that tumor control and survival rates for SRS alone after chordoma surgery were not inferior to those encountered after SRS plus fractionated RT.
摘要：
这项回顾性研究的目的是比较经活检证实的颅底脊索瘤患者的生存率，这些患者接受了立体定向放射外科手术（SRS），但没有接受分割放射治疗（RT）。
从数据库开始到2021年9月的相关文章是从PubMed检索的，Scopus,WebofScience,和Cochrane数据库对治疗方案进行系统评价。包括以下情况的研究：1）涉及经组织学和放射学证实位于斜坡颅底区域内并接受SRS治疗的成人患者（年龄≥18岁）；2）报告的临床特征数据，SRS协议,和结果；和3）用英语写的。如果研究1)是文献综述，则将其排除在外，病例报告,技术说明,摘要,或尸检报告；2）没有明确区分脊索瘤患者的数据与不同肿瘤患者的数据或颅底以外位置的脊索瘤患者的数据；或3）缺乏组织学确认或治疗和结果数据。提取的数据包括：研究作者和发表年份，患者年龄和性别,症状,颅神经受累,入侵的结构，病变大小,治疗方式，手术细节,组织病理学类型,RT模态,SRS参数,并发症,术后结果，并发症,和生存结果。
在选择过程之后，15篇文章描述了130名符合研究资格标准的患者，包括94例接受手术后SRS(NoRT组)和36例接受手术后分割RT和后续SRS(RT组)的患者.NoRT和RT组的年龄相当（51.3岁vs47.4岁，分别)，性别(57.1%vs男性58.3%)，肿瘤体积（9.5对11.2cm3），SRS治疗参数（最大剂量：35.4对42.2Gy，边际剂量：19.6vs20.6Gy，治疗等剂量线：60.2%vs65.2%），和SRS不良反应（10.9%vs17.6%）。对于整个队列，3-,5-,10年无进展生存率（PFS）为23％，9%,3%,分别,总生存率（OS）为94%，82%,76%,分别。在NoRT组中，38例(40.4%)患者在手术切除后接受SRS辅助治疗,10例（10.6%）单独切除复发肿瘤的抢救治疗，和46（48.9%）中未指定。在RT组中，9例患者(25.0%)接受SRS强化治疗,复发后的抢救治疗22例（61.1%），而在5中未指定（13.9%）。两组间PFS中位数无差异（24.0个月[Q134.0,Q315.0]vs23.8个月[34.0,18.0]，分别为；p=0.8)或中位OS(293.0个月[未达到，137.4]vs未达到[未达到，48.0],分别为；p=0.36)。两组之间的辐射不良反应发生率相当（10.9％vs17.6％，分别为；p=0.4)。
SRS在颅底脊索瘤治疗中的作用仍在不断发展。对活检证实的脊索瘤的系统文献回顾显示，脊索瘤手术后单纯SRS的肿瘤控制率和生存率并不逊于SRS加分割RT后的肿瘤控制率和生存率。
从数据库开始到2021年9月的相关文章是从PubMed检索的，Scopus,WebofScience,和Cochrane数据库对治疗方案进行系统评价。包括以下情况的研究：1）涉及经组织学和放射学证实位于斜坡颅底区域内并接受SRS治疗的成人患者（年龄≥18岁）；2）报告的临床特征数据，SRS协议,和结果；和3）用英语写的。如果研究1)是文献综述，则将其排除在外，病例报告,技术说明,摘要,或尸检报告；2）没有明确区分脊索瘤患者的数据与不同肿瘤患者的数据或颅底以外位置的脊索瘤患者的数据；或3）缺乏组织学确认或治疗和结果数据。提取的数据包括：研究作者和发表年份，患者年龄和性别,症状,颅神经受累,入侵的结构，病变大小,治疗方式，手术细节,组织病理学类型,RT模态,SRS参数,并发症,术后结果，并发症,和生存结果。
在选择过程之后，15篇文章描述了130名符合研究资格标准的患者，包括94例接受手术后SRS(NoRT组)和36例接受手术后分割RT和后续SRS(RT组)的患者.NoRT和RT组的年龄相当（51.3岁vs47.4岁，分别)，性别(57.1%vs男性58.3%)，肿瘤体积（9.5对11.2cm3），SRS治疗参数（最大剂量：35.4对42.2Gy，边际剂量：19.6vs20.6Gy，治疗等剂量线：60.2%vs65.2%），和SRS不良反应（10.9%vs17.6%）。对于整个队列，3-,5-,10年无进展生存率（PFS）为23％，9%,3%,分别,总生存率（OS）为94%，82%,76%,分别。在NoRT组中，38例(40.4%)患者在手术切除后接受SRS辅助治疗,10例（10.6%）单独切除复发肿瘤的抢救治疗，和46（48.9%）中未指定。在RT组中，9例患者(25.0%)接受SRS强化治疗,复发后的抢救治疗22例（61.1%），而在5中未指定（13.9%）。两组间PFS中位数无差异（24.0个月[Q134.0,Q315.0]vs23.8个月[34.0,18.0]，分别为；p=0.8)或中位OS(293.0个月[未达到，137.4]vs未达到[未达到，48.0],分别为；p=0.36)。两组之间的辐射不良反应发生率相当（10.9％vs17.6％，分别为；p=0.4)。
SRS在颅底脊索瘤治疗中的作用仍在不断发展。对活检证实的脊索瘤的系统文献回顾显示，脊索瘤手术后单纯SRS的肿瘤控制率和生存率并不逊于SRS加分割RT后的肿瘤控制率和生存率。
