Kralik Stephen F, Watson Gordon A, Shih Chie-Schin, Ho Chang Y, Finke Whitney, Buchsbaum Jeffrey
Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):817-824. doi: 10.1016/j.ijrobp.2017.07.009. Epub 2017 Jul 12.
The purpose of this research was to evaluate the incidence, time to development, imaging patterns, risk factors, and clinical significance of large vessel cerebral vasculopathy in pediatric patients with brain tumors treated with proton radiation therapy.
A retrospective study was performed on 75 consecutive pediatric patients with primary brain tumors treated with proton radiation therapy. Radiation-induced large vessel cerebral vasculopathy (RLVCV) was defined as intracranial large vessel arterial stenosis or occlusion confirmed on magnetic resonance angiography, computed tomographic angiography, catheter angiography, or a combination of these within an anatomic region with previous exposure to proton beam therapy and not present before radiation therapy. Clinical records were used to determine the incidence, timing, radiation dose to the large vessels, and clinical significance associated with the development of large vessel vasculopathy in these patients.
RLVCV was present in 5 of 75 (6.7%) patients and included tumor pathologic features of craniopharyngioma (n=2), ATRT (n=1), medulloblastoma (n=1), and anaplastic astrocytoma (n=1). The median time from completion of radiation therapy to development was 1.5 years (mean, 3.0 years; range, 1.0-7.5 years). Neither mean age at the time of radiation therapy (5.1 years) nor mean radiation therapy dose to the large vessels (54.5 Gy) was a statistically significant risk factor. Four of the 5 patients with RLVCV presented with acute stroke and demonstrated magnetic resonance imaging evidence of acute infarcts in the expected vascular distributions. Angiography studies demonstrated collateral vessel formation in only 2 of the patients with RLVCV. No patients demonstrated acute hemorrhage or aneurysm. Two patients were treated with pial synangiomatosis surgery.
RLVCV can occur in pediatric patients with brain tumors treated with proton radiation therapy. Further studies are necessary to determine potential risk factors for large vessel vasculopathy with proton radiation therapy in comparison with conventional photon radiation therapy.
本研究旨在评估接受质子放射治疗的小儿脑肿瘤患者大血管性脑血管病的发生率、发病时间、影像学表现、危险因素及临床意义。
对75例连续接受质子放射治疗的小儿原发性脑肿瘤患者进行回顾性研究。放射诱导的大血管性脑血管病（RLVCV）定义为在先前接受质子束治疗的解剖区域内，通过磁共振血管造影、计算机断层血管造影、导管血管造影或这些检查的组合确诊的颅内大血管动脉狭窄或闭塞，且在放射治疗前不存在。临床记录用于确定这些患者中大血管性血管病的发生率、发病时间、大血管的放射剂量以及与发病相关的临床意义。
75例患者中有5例（6.7%）出现RLVCV，其肿瘤病理特征包括颅咽管瘤（n = 2）、非典型畸胎样/横纹肌样瘤（ATRT，n = 1）、髓母细胞瘤（n = 1）和间变性星形细胞瘤（n = 1）。从放射治疗结束到发病的中位时间为1.5年（平均3.0年；范围1.0 - 7.5年）。放射治疗时的平均年龄（5.1岁）和大血管的平均放射治疗剂量（54.5 Gy）均不是具有统计学意义的危险因素。5例RLVCV患者中有4例出现急性卒中，并在预期的血管分布区域显示出急性梗死的磁共振成像证据。血管造影研究显示，只有2例RLVCV患者出现侧支血管形成。没有患者出现急性出血或动脉瘤。2例患者接受了软膜联合血管成形术手术。
接受质子放射治疗的小儿脑肿瘤患者可发生RLVCV。与传统光子放射治疗相比，有必要进一步研究确定质子放射治疗导致大血管性血管病的潜在危险因素。
