Ares Carmen, Albertini Francesca, Frei-Welte Martina, Bolsi Alessandra, Grotzer Michael A, Goitein Gudrun, Weber Damien C
Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland.
Department of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland.
J Neurooncol. 2016 May;128(1):137-145. doi: 10.1007/s11060-016-2090-4. Epub 2016 Mar 5.
To assess the clinical outcome and late side effect profile of pencil beam scanning proton therapy (PT) delivered to children with intracranial ependymoma. Between July-2004 and March-2013, 50 patients with intracranial ependymoma (n = 46, grade 3) received involved-field PT at Paul Scherrer Institute (PSI). Median age at time of PT was 2.6 years (range 1.1-15.2). Thirty-six patients had infratentorial and 14 supratentorial ependymomas. Seventeen patients presented with macroscopic residual disease after subtotal resection before starting PT (8 with ≤1.5 cc and 9 with >1.5 cc residual tumor respectively). Forty-three (86 %) patients received post-operative chemotherapy before PT according to protocols; 44 (88 %) patients younger than 5 years required general anesthesia. Median prescribed dose was 59.4 Gy (RBE) (range 54-60) delivered in 1.8-2 Gy (RBE) per fraction. Late toxicity was assessed according to CTCAE v4.0. With a mean follow-up time of 43.4 months (range 8.5-113.7) seven patients experienced local failure (6 with infratentorial tumors and 1 with supratentorial tumor); four of the local failures were in patients with residual disease ≥1.5 cc at the time of PT and 3 without residual macroscopic disease. Five patients died from tumor progression. Actuarial 5-year Local Control rates were 78 ± 7.5 % and 5-year OS rates were 84 ± 6.8 %. Three patients developed grade ≥3 toxicity: 2 developed unilateral deafness (infratentorial tumors infiltrating into the internal acoustic canal), one patient developed a fatal brainstem necrosis. Repeated general anesthesia in children younger than 5 years was delivered without complications. Our data indicate the safety and the effectiveness of PT for pediatric ependymomas. Local control and survival rates are encouraging considering the high grade histology in 92 % of the patients and the number of patients with residual tumor ≥1.5 cc. The rates of late effects compare favorably with published photon-treated cohorts.
评估笔形束扫描质子治疗（PT）对颅内室管膜瘤患儿的临床疗效及晚期副作用情况。2004年7月至2013年3月期间，50例颅内室管膜瘤患者（46例为3级）在保罗·谢尔研究所（PSI）接受了受累野PT治疗。PT时的中位年龄为2.6岁（范围1.1 - 15.2岁）。36例患者为幕下室管膜瘤，14例为幕上室管膜瘤。17例患者在开始PT前次全切除术后存在肉眼可见的残留病灶（分别有8例残留肿瘤≤1.5 cc，9例残留肿瘤>1.5 cc）。43例（86%）患者根据方案在PT前接受了术后化疗；44例（88%）5岁以下患者需要全身麻醉。中位处方剂量为59.4 Gy（相对生物效应）（范围54 - 60），每次分割剂量为1.8 - 2 Gy（相对生物效应）。根据CTCAE v4.0评估晚期毒性。平均随访时间为43.4个月（范围8.5 - 113.7个月），7例患者出现局部复发（6例幕下肿瘤患者，1例幕上肿瘤患者）；其中4例局部复发患者在PT时残留病灶≥1.5 cc，3例无肉眼可见残留病灶。5例患者死于肿瘤进展。5年实际局部控制率为78 ± 7.5%，5年总生存率为84 ± 6.8%。3例患者出现≥3级毒性反应：2例出现单侧耳聋（幕下肿瘤浸润至内听道），1例患者发生致命性脑干坏死。5岁以下儿童重复进行全身麻醉未出现并发症。我们的数据表明PT治疗儿童室管膜瘤具有安全性和有效性。考虑到92%的患者组织学分级高以及残留肿瘤≥1.5 cc的患者数量，局部控制率和生存率令人鼓舞。晚期效应发生率与已发表的光子治疗队列相比具有优势。
