Schiopu Sanziana R I, Habl Gregor, Häfner Matthias, Katayama Sonja, Herfarth Klaus, Debus Juergen, Sterzing Florian
Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
Klinikum rechts der Isar, Department of Radiation Oncology, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
J Radiat Res. 2017 Mar 1;58(2):238-246. doi: 10.1093/jrr/rrw095.
The aim of this study was to describe early and late toxicity, survival and local control in 45 patients with primary brain tumors treated with helical tomotherapy craniospinal irradiation (HT-CSI). From 2006 to 2014, 45 patients with central nervous system malignancies were treated with HT-CSI. The most common tumors were medulloblastoma in 20 patients, ependymoma in 10 patients, intracranial germinoma (ICG) in 7 patients, and primitive neuroectodermal tumor in 4 patients. Hematological toxicity during treatment included leukopenia Grades 1-4 (6.7%, 33.3%, 37.8% and 17.8%, respectively), anemia Grades 1-4 (44.4%, 22.2%, 22.2% and 0%, respectively) and thrombocytopenia Grades 1-4 (51.1%, 15.6%, 15.6% and 6.7%, respectively). The most common acute toxicities were nausea, vomiting, fatigue, loss of appetite, alopecia and neurotoxicity. No Grade 3 or higher late toxicity occurred. The overall 3- and 5-year survival rates were 80% and 70%, respectively. Survival for the main tumor entities included 3- and 5-year survival rates of 80% and 70%, respectively, for patients with medulloblastoma, 70% for both in patients with ependymoma, and 100% for both in patients with ICG. Relapse occurred in 11 patients (24.4%): 10 with local and 1 with multifocal relapse. One patient experienced a secondary cancer. M-status and the results of the re-evaluation at the end of treatment were significantly related to survival. Survival after HT-CSI was in line with the existing literature, and acute treatment-induced toxicity resolved quickly. Compared with conventional radiotherapy, HT offers benefits such as avoiding gaps and junctions, sparing organs, and better and more homogeneous dose distribution and coverage of the target volume.
本研究的目的是描述45例接受螺旋断层放射治疗全脑全脊髓照射（HT-CSI）的原发性脑肿瘤患者的早期和晚期毒性反应、生存率及局部控制情况。2006年至2014年期间，45例中枢神经系统恶性肿瘤患者接受了HT-CSI治疗。最常见的肿瘤类型为：20例髓母细胞瘤、10例室管膜瘤、7例颅内生殖细胞瘤（ICG）和4例原始神经外胚层肿瘤。治疗期间的血液学毒性反应包括1-4级白细胞减少（分别为6.7%、33.3%、37.8%和17.8%）、1-4级贫血（分别为44.4%、22.2%、22.2%和0%）以及1-4级血小板减少（分别为51.1%、15.6%、15.6%和6.7%）。最常见的急性毒性反应为恶心、呕吐、疲劳、食欲减退、脱发和神经毒性。未发生3级或更高级别的晚期毒性反应。3年和5年总生存率分别为80%和70%。主要肿瘤实体的生存率如下：髓母细胞瘤患者的3年和5年生存率分别为80%和70%，室管膜瘤患者均为70%，ICG患者均为100%。11例患者（24.4%）出现复发：10例为局部复发，1例为多灶性复发。1例患者发生了继发性癌症。M状态及治疗结束时的重新评估结果与生存率显著相关。HT-CSI后的生存率与现有文献一致，且急性治疗引起的毒性反应消退迅速。与传统放疗相比，HT具有避免间隙和衔接、保护器官以及剂量分布和靶区覆盖更好且更均匀等优势。
