Neoadjuvant Radiation Therapy vs. Neoadjuvant Chemoradiation Therapy in Spinal Chordomas: Systematic review of 447 patients

Introduction: Spinal chordomas represent 2-4% of all primary tumors of the central nervous system (CNS). These tumors can occur within or adjacent to the spinal cord and manifestate either primary or metastatic in its origin. Both neoadjuvant chemoradiation and neoadjuvant radiation are available treatments and have shown benefits in treatment of spinal chordomas. In this review, we aim to evaluate the outcomes of neoadjuvant radiation compared to neoadjuvant chemoradiation in the prognosis of spinal chordomas.

Methods: This large-scale systematic review was conducted according to PRISMA guidelines. Notable databases were utilized for sources: Pubmed, Embase, and Web of Science. Baseline characteristics, doses, outcomes, survival, follow-up time, revision surgery, tumor locations, receipt of surgery, agent sequence and regimen, progression, and recurrence of neoadjuvant radiotherapy and/or chemotherapy were evaluated. Screening was done with Rayyan.ai and quality assessment was done with the Joanna-Briggs critical appraisal research tool.

Results: 12 studies were included in this review encompassing 447 patients. Spinal chordomas primarily occur in the sacral region (63.6%), followed by lumbar (20.3%), cervical (18.0%), thoracic (11.7%), and coccygeal (7.0%) regions. High overall survival rates at 1, 3, and 5 years, along with a notable local progression-free survival rate of 90% is shown consistently in neoadjuvant radiation therapy. In contrast, neoadjuvant chemoradiation therapy has lower 5-year survival rates, especially for intralesional (45.6%) and marginal (56.7%). Neoadjuvant chemoradiation therapy has a lower recurrence rate (22.3%) than the average for neoadjuvant radiation therapy, which experiences recurrences more rapidly (within 3.6 months) and has a significant percentage of patients (30%) recurring within 2.4 years.

Conclusion : Based on survival, recurrence, and other analyzed outcomes, neoadjuvant radiation therapy proves better than neoadjuvant chemoradiation. This may be the preferred option for patients, but this also emphasizes further need to validate.