Evidence map›Paper›PMID 42414660›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Comparative outcomes of proton and photon therapy in the management of malignant peripheral nerve sheath tumors.

Taha Khalilullah, Abdul Karim Ghaith, Xinlan Yang, Bibhas Amatya, Xihang Wang, Leon Fan, Arman Momeni, Nathan Kim, Jawad Khalifeh, Joshua Weinberg and 10 more

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Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. 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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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

20 authors.

Taha KhalilullahJohns Hopkins University, Baltimore, USA.
Abdul Karim GhaithJohns Hopkins University, Baltimore, USA. abdulkarimghaith@gmail.com.ORCID https://orcid.org/0000-0002-9600-609X
Xinlan YangJohns Hopkins University, Baltimore, USA.
Bibhas AmatyaJohns Hopkins University, Baltimore, USA.
Xihang WangJohns Hopkins University, Baltimore, USA.
Leon FanJohns Hopkins University, Baltimore, USA.
Arman MomeniJohns Hopkins University, Baltimore, USA.
Nathan KimJohns Hopkins University, Baltimore, USA.
Jawad KhalifehJohns Hopkins University, Baltimore, USA.
Joshua WeinbergThe Ohio State University, Columbus, USA.
Tej AzadJohns Hopkins University, Baltimore, USA.
Yuanxuan XiaJohns Hopkins University, Baltimore, USA.
Maher GhandourJohns Hopkins University, Baltimore, USA.
Allan BelzbergJohns Hopkins University, Baltimore, USA.
Kristin RedmondJohns Hopkins University, Baltimore, USA.
Yazan AlasadiJohns Hopkins University, Baltimore, USA.
Danner ButlerUniversity of Alabama, Birmingham, USA.
Madison PatrickUniversity of Alabama, Birmingham, USA.
Nicholas TheodoreUniversity of Arizona, Phoenix, USA.
Daniel LubelskiJohns Hopkins University, Baltimore, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMalignant Peripheral Nerve Sheath Tumors (MPNSTs) are aggressive sarcomas often arising in the spine, characterized by high metastatic potential and poor prognosis. While photon radiation therapy (RT) has been employed for local control, the role of proton RT in spinal MPNST remains poorly defined. Our objective is to compare treatment patterns, survival outcomes, and predictors of mortality among spinal MPNST patients treated with photon vs. proton RT.

methodsThis retrospective cohort study utilized the National Cancer Database (2004-2017) to identify patients with spinal MPNST. Demographics, tumor characteristics, treatment details, and outcomes were compared between patients receiving no radiation, photon RT, or proton RT. Survival was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Machine learning-based survival models evaluated predictive performance, feature importance, and SHAP values.

resultsOf 5,664 spinal MPNST patients, 3,264 (57.3%) received RT (photon: 97.5%; proton: 2.5%). Proton therapy recipients were younger, had smaller tumors, and more frequently received adjuvant chemoradiation (p < 0.001). Proton therapy was associated with significantly improved 10-year survival (88.5% vs. 73.8%; p = 0.003) and lower long-term mortality (HR: 0.47; p = 0.024). Comorbidity burden, distant metastasis, and high biologically effective dose (BED > 70 Gy) were predictors of both short- and long-term mortality on the multivariate model. The Gradient Boosting model identified BED, CDCC score, and tumor size as the most influential predictors, with a highest AUC for 10-year mortality of 0.715.

conclusionProton therapy is associated with superior long-term survival compared to photon therapy in spinal MPNST patients, particularly among the subtotal resection cohort. Radiation dose, tumor size, and comorbidity burden are strong predictors of mortality. These findings support the integration of proton therapy into treatment algorithms and emphasize the importance of individualized, risk-adapted strategies to improve survival in patients with spinal MPNST.

Indexed as

Machine learningMPNSTNCDB.Photon therapyProton therapyRadiation oncology

Identifiers

PMID42414660

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