Harvard Radiation Oncology Program, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):1015-22. doi: 10.1016/j.ijrobp.2011.08.035. Epub 2011 Dec 3.
To report the early outcomes for children with high-risk neuroblastoma treated with proton radiotherapy (RT) and to compare the dose distributions for intensity-modulated photon RT (IMRT), three-dimensional conformal proton RT (3D-CPT), and intensity-modulated proton RT to the postoperative tumor bed.
All patients with high-risk (International Neuroblastoma Staging System Stage III or IV) neuroblastoma treated between 2005 and 2010 at our institution were included. All patients received induction chemotherapy, surgical resection of residual disease, high-dose chemotherapy with stem cell rescue, and adjuvant 3D-CPT to the primary tumor sites. The patients were followed with clinical examinations, imaging, and laboratory testing every 6 months to monitor disease control and side effects. IMRT, 3D-CPT, and intensity-modulated proton RT plans were generated and compared for a representative case of adjuvant RT to the primary tumor bed followed by a boost.
Nine patients were treated with 3D-CPT. The median age at diagnosis was 2 years (range 10 months to 4 years), and all patients had Stage IV disease. All patients had unfavorable histologic characteristics (poorly differentiated histologic features in 8, N-Myc amplification in 6, and 1p/11q chromosomal abnormalities in 4). The median tumor size at diagnosis was 11.4 cm (range 7-16) in maximal dimension. At a median follow-up of 38 months (range 11-70), there were no local failures. Four patients developed distant failure, and, of these, two died of disease. Acute side effects included Grade 1 skin erythema in 5 patients and Grade 2 anorexia in 2 patients. Although comparable target coverage was achieved with all three modalities, proton therapy achieved substantial normal tissue sparing compared with IMRT. Intensity-modulated proton RT allowed additional sparing of the kidneys, lungs, and heart.
Preliminary outcomes reveal excellent local control with proton therapy for high-risk neuroblastoma, although distant failures continu to occur. Dosimetric comparisons demonstrate the advantage of proton RT compared with IMRT in this setting, allowing more conformal treatment and better normal tissue sparing.
报告采用质子放射治疗（RT）治疗高危神经母细胞瘤儿童的早期结果，并比较调强光子 RT（IMRT）、三维适形质子 RT（3D-CPT）和调强质子 RT 的剂量分布与术后肿瘤床的关系。
所有在我院于 2005 年至 2010 年间接受治疗的高危（国际神经母细胞瘤分期系统 III 或 IV 期）神经母细胞瘤患者均被纳入本研究。所有患者均接受诱导化疗、残余疾病的手术切除、大剂量化疗加干细胞挽救，以及原发肿瘤部位的辅助 3D-CPT。通过每 6 个月进行临床检查、影像学检查和实验室检查来监测疾病控制和副作用，对患者进行随访。为了对原发性肿瘤床进行辅助性 RT 并进行强化治疗，我们生成了 IMRT、3D-CPT 和调强质子 RT 计划，并对一个代表性病例进行了比较。
9 例患者接受了 3D-CPT 治疗。诊断时的中位年龄为 2 岁（范围为 10 个月至 4 岁），所有患者均患有 IV 期疾病。所有患者均具有不良组织学特征（8 例为分化差的组织学特征，6 例为 N-Myc 扩增，4 例为 1p/11q 染色体异常）。诊断时肿瘤的最大直径中位数为 11.4cm（范围为 7-16cm）。在中位随访时间为 38 个月（范围为 11-70 个月）时，无局部复发。4 例患者发生远处转移失败，其中 2 例死于疾病。急性副作用包括 5 例患者出现 1 级皮肤红斑和 2 例患者出现 2 级食欲不振。尽管所有三种方式均能达到相似的靶区覆盖，但质子治疗与 IMRT 相比，能显著减少正常组织的受照剂量。调强质子 RT 可进一步保护肾脏、肺和心脏。
初步结果显示，质子治疗高危神经母细胞瘤的局部控制效果极佳，但远处转移仍有发生。剂量学比较表明，与 IMRT 相比，质子 RT 具有优势，能实现更适形的治疗和更好的正常组织保护。
