The Role of Radiotherapy for Chordoma Patients Managed With Surgery: Analysis of the National Cancer Database.
The Role of Radiotherapy for Chordoma Patients Managed With Surgery: Analysis of the National Cancer Database.
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DOI：
10.1097/brs.0000000000003406
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发表时间：
2020-06-15
期刊：
影响因子：
3
通讯作者：
Mendoza-Lattes SA
中科院分区：
文献类型：
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作者：
Dial BL;Kerr DL;Lazarides AL;Catanzano AA;Green CL;Risoli T Jr;Blazer DG;Goodwin RC;Brigman BE;Eward WC;Larrier NA;Kirsch DG;Mendoza-Lattes SA
回顾性分析旨在确定辅助放疗（RT）是否可改善脊索瘤手术切除后的总生存期（OS）。RT治疗脊索瘤的作用仍然不完全描述。以前的研究没有发现辅助RT可以改善OS，但这些研究没有根据手术切缘状态或放射剂量或方式对患者进行分组。我们使用国家癌症数据库来研究RT在手术切除后脊索瘤中的作用。根据手术切缘状态（阳性vs阴性）对患者进行分层。使用Kaplan Meier方法，比较了治疗方式（单独手术切除、单独治疗性RT和手术切除加治疗性RT）之间的OS。随后比较接受姑息剂量（<40 Gy）、低剂量（40- 65 Gy）和高剂量（> 65 Gy）RT治疗的患者的OS。同样，比较高级RT模式（包括质子束治疗（PBT）和调强放射治疗（IMRT）、立体定向放射外科（SRS）和外束放射治疗（EBRT））的OS。采用多变量模型确定预测死亡率的调整变量。确定了1，478名脉络膜患者;颅底（n=567）、骶骨（n=551）和移动的脊柱（n=360）。手术切除和辅助放疗可提高切缘阳性患者的5年生存率（82% vs 71%，p= 0.03）。在手术切缘阴性的患者中，没有观察到增加辅助RT的明显生存益处。与姑息性和低剂量RT相比，高剂量RT与OS改善相关（p<0.001）。与EBRT相比，高级RT技术和SRS与OS改善相关。在多因素分析中，大剂量晚期放疗（> 65 Gy）上级EBRT。手术切缘阳性的患者从辅助RT中获益。最佳OS与采用先进技术和累积剂量>65戈伊的辅助RT相关。本研究的目的是确定放射治疗（RT）在手术切除后的脉络膜患者中的作用。对1，478例脉络膜炎患者进行了回顾性分析。治疗性RT可提高手术切缘阳性患者的生存率。
Retrospective review To determine if adjuvant radiation therapy (RT) improves overall survival (OS) following surgical resection of chordomas. The role of RT for the treatment of chordomas remains incompletely described. Previous studies have not found adjuvant RT to improve OS, but these studies did not group patients based on surgical margin status or radiation dose or modality. We used the National Cancer Database to investigate the role of RT in chordomas following surgical resection. Patients were stratified based on surgical margin status (positive vs negative). Utilizing the Kaplan Meier method, OS was compared between treatment modalities (surgical resection alone, therapeutic RT alone, and surgical resection plus therapeutic RT). OS was subsequently compared between patients treated with palliative dose (<40Gy), low dose (40– 65Gy), and high dose (>65Gy) RT. Similarly, OS was compared between advanced RT modalities including proton beam therapy (PBT) and intensity-modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), and external beam radiation therapy (EBRT). A multivariable model was used to determine adjusted variables predictive of mortality. 1,478 chordoma patients were identified; skull base (n=567), sacral (n=551), and mobile spine (n=360). Surgical resection and therapeutic adjuvant RT improved 5-year survival in patients with positive surgical margins (82% vs 71%, p=0·03). No clear survival benefit was observed with the addition of adjuvant RT in patients with negative surgical margins. High dose RT was associated with improved OS compared to palliative and low dose RT (p<0·001). Advanced RT techniques and SRS were associated with improved OS compared to EBRT. In the multivariate analysis high dose advanced RT (>65Gy) was superior to EBRT. Patients with positive surgical margins benefit from adjuvant RT. Optimal OS is associated with adjuvant RT administered with advanced techniques and cumulative dose >65 Gy. The purpose of this study was to determine the role for radiation therapy (RT) in chordoma patients following surgical resection. A retrospective review of 1,478 chordoma patients was performed. Therapeutic RT improves survival in the setting of positive surgical margins.