Evidence map›Paper›PMID 40563064›Full record

ArticleJournal of neuro-oncology2025

Impact of proton versus photon radiotherapy on overall survival in the management of spinal chordoma and mortality risk prediction: a nationwide analysis.

Abdul Karim Ghaith, Xinlan Yang, Taha Khalilullah, Linda Tang, Hasan Radwan, Joshua Weinberg, Jawad Khalifeh, A Karim Ahmed, Tej Azad, Chase Foster and 3 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Journal of neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Abdul Karim GhaithDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
Xinlan YangDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
Taha KhalilullahDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
Linda TangDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
Hasan RadwanSchool of Medicine, Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
Joshua WeinbergSchool of Medicine, Department of Neurosurgery, Ohio State University, Columbus, OH, USA.
Jawad KhalifehDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
A Karim AhmedDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
Tej AzadDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
Chase FosterSchool of Medicine, Department of Neurosurgery, George Washington, Washington, VA, USA.
Nicholas TheodoreDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA.
Kristin J RedmondDepartment of Radiation Oncology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
Daniel LubelskiDepartment of Neurosurgery, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street/Meyer 5-181, Baltimore, MD, 21287, USA. dlubelski@jhmi.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study aims to provide a national-level insight into the optimal management of spinal chordoma, a type of rare and complicated malignancy, and to identify effective radiation therapy (RT) strategies for patients with spinal chordoma by comparing photon versus proton therapies.

methodsPatients with histologically confirmed spinal chordoma were identified from the NCDB. Patients' demographics, disease characteristics and treatments were compared between the radiation and no-radiation groups. Kaplan-Meier assessed 10-year overall survival (OS). Multivariate Cox regression and machine learning models-Random Survival Forest and Gradient Boosting-identified predictive factors and thresholds of tumor size for mortality risk, with SHAP used to quantify predictor importance.

resultsOf 1204 patients, 495 (41.1%) received RT; 73.9% received photons and 26.1% protons. GTR significantly improved OS compared to STR (p < 0.0001). RT was associated with reduced short-term morality at 90-days (p = 0.025) and 1-year (p = 0.016). Proton therapy showed superior 10-year OS compared to photon therapy (p = 0.019). Beam technology, BED dose, sequence, and reirradiation had minimal impact on OS. Cox regression identified age (HR = 1.03, p < 0.001), STR (HR = 1.42, p = 0.005), and proton therapy (HR = 0.58, p = 0.044) as independent mortality predictors. Machine learning identified tumor size thresholds (photons: 83 mm; protons: 70 mm) and ranked age, tumor size, and EOR as top survival predictors.

conclusionAggressive surgical resection (GTR) remains the primary treatment for spinal chordoma. Proton therapy that allows for dose escalation provided 10-year survival benefits compared to photon therapy. Age, tumor size and EOR are important factors in predicting 10-year mortality risk.

Indexed as

ChordomaPhotonsProton TherapySpinal NeoplasmsAdultAgedAged, 80 and overFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisSurvival RateYoung AdultProton therapyRadiation therapySpinal chordomaSurvival prediction

Identifiers

PMID40563064

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.