Lucas John T, Cooper David A, Hwang Scott, Tinkle Christopher, Li Xingyu, Li Yimei, Orr Brent, Merchant Thomas E, Broniscer Alberto
Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Int J Radiat Oncol Biol Phys. 2017 Oct 1;99(2):450-458. doi: 10.1016/j.ijrobp.2017.04.039. Epub 2017 May 4.
We sought to investigate the pattern of treatment failure with respect to anatomic extent, radiation dose, and criteria for failure according to the Response Assessment in Neuro-Oncology (RANO). We evaluated the corresponding prognostic significance of these factors in patients with pediatric high-grade glioma (pHGG).
Fifty-six patients with pHGG were enrolled in an institutional phase 1 to 2 prospective trial that included maximal safe resection and radiation therapy with concurrent and adjuvant erlotinib. The radiation therapy dose administered was 54 to 59.4 Gy at 1.8 Gy/d. Tumor progression was defined according to clinical symptoms and imaging features and was classified in relation to the original extent of the tumor, radiation prescription target volume coverage, and RANO criteria (RANOc).
With a median follow-up period of 90 months (range, 70-124 months), progression occurred in 48 patients (85.7%) while 8 (14.3%) were without progression. Central failure represented 42.6% of the total cohort, while in-field, marginal, and distant failures occurred in 7.4%, 9.3%, and 22.2%, respectively. Patients with biopsy or subtotal resection had increased rates of central failure and represented 14.81% and 16.67% of the total cohort, respectively. Tumor progression was classified as local, local plus distant, or distant. Among patients with local failure as a component of failure, 5 were considered to have marginal failure. Patients with frontal, temporal, and parietal disease had the highest rates of multifocal failure. A comparison between responses defined by RANOc demonstrated varied time to death (TTD) from progression.
Pediatric high-grade glioma was shown to have high rates of central failure, particularly in cases with limited resection. Patients with central failure had a trend toward more prolonged TTD from failure relative to other failure patterns. The low marginal failure rates seen in this group suggest that less conservative radiation target margins may be possible. TTD from failure varied according to RANO type, suggesting that adult RANOc require modification before being applied to pHGG.
我们试图研究治疗失败模式与解剖范围、放射剂量以及根据神经肿瘤学反应评估（RANO）标准判定的失败标准之间的关系。我们评估了这些因素在小儿高级别胶质瘤（pHGG）患者中的相应预后意义。
56例pHGG患者参加了一项机构性1至2期前瞻性试验，该试验包括最大安全切除以及同步和辅助使用厄洛替尼的放射治疗。放射治疗剂量为1.8 Gy/d，总量54至59.4 Gy。根据临床症状和影像学特征定义肿瘤进展，并根据肿瘤的原始范围、放射处方靶区覆盖情况和RANO标准（RANOc）进行分类。
中位随访期为90个月（范围70 - 124个月），48例患者（85.7%）出现进展，8例（14.3%）无进展。中心性失败占总队列的42.6%，而野内、边缘和远处失败分别占7.4%、9.3%和22.2%。活检或次全切除的患者中心性失败率增加，分别占总队列的14.81%和16.67%。肿瘤进展分为局部、局部加远处或远处进展。在以局部失败为失败组成部分的患者中，5例被认为是边缘性失败。额叶、颞叶和顶叶病变的患者多灶性失败率最高。根据RANOc定义的反应之间的比较显示，从进展到死亡的时间（TTD）各不相同。
小儿高级别胶质瘤显示出较高的中心性失败率，尤其是在切除范围有限的病例中。与其他失败模式相比，中心性失败的患者从失败到TTD有延长的趋势。该组中较低的边缘性失败率表明，放射靶区边缘可能无需那么保守。从失败到TTD因RANO类型而异，这表明成人RANOc在应用于pHGG之前需要修改。
