Breen William, Bancos Irina, Young William F, Bible Keith C, Laack Nadia N, Foote Robert L, Hallemeier Christopher L
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
Adv Radiat Oncol. 2017 Nov 22;3(1):25-29. doi: 10.1016/j.adro.2017.11.002. eCollection 2018 Jan-Mar.
PURPOSE/OBJECTIVES: To evaluate the role of external beam radiation therapy (EBRT) for treatment of malignant paraganglioma (PGL) and pheochromocytoma (PCC).
A retrospective review was performed of all patients with malignant PGL/PCC treated with EBRT at our institution between 1973 and 2015. Local control (LC) per treated lesion and overall survival were estimated using the Kaplan-Meier method. Toxicities were scored using the Common Toxicity Criteria for Adverse Events (AE), version 4.
The cohort included 41 patients with 107 sites treated. Median (range) age at EBRT was 33 (11-80) years. Treatment intention was curative in 20 patients (30 lesions) and palliative in 21 patients (77 lesions). The primary tumor was PGL (63%) and PCC (37%). Previous local therapies were surgical resection (90%) and percutaneous ablation (19%). Indications for EBRT were local control (66%), pain (22%), or spinal cord compression (12%). Treatment site included bone (69%), soft tissue (30%), and liver (1%). Median (range) EBRT dose was 40 (6.5-70) Gy. Median biologic effective dose using α/β = 10 (BED) was 53 (9-132). Median follow-up was 3.8 years (0.04-41.5), and mean follow-up was 9.7 years. Overall survival at 5 years was 65%: 79% for curative- and 50% for palliative-intention patients ( = .028). LC at 5 years was 81% for all lesions; 91% for lesions receiving BED ≥53, and 62% for lesions receiving BED <53 ( = .001). All 11 lesions treated with stereotactic body RT or radiosurgery had LC at a median of 3.0 (0.2-5.4) years. For the symptomatic lesions, symptoms improved in 94%. There were no acute grade ≥3 treatment-related AEs, including no hypertensive crises. Two patients developed a late grade ≥3 AE.
EBRT is a useful treatment modality for malignant PGL and PCC. Higher RT dose was associated with improved LC.
目的/目标：评估外照射放疗（EBRT）在治疗恶性副神经节瘤（PGL）和嗜铬细胞瘤（PCC）中的作用。
对1973年至2015年间在我们机构接受EBRT治疗的所有恶性PGL/PCC患者进行回顾性研究。采用Kaplan-Meier方法评估每个治疗病灶的局部控制（LC）和总生存率。使用不良事件通用毒性标准（AE）第4版对毒性进行评分。
该队列包括41例患者，共治疗107个部位。EBRT时的中位（范围）年龄为33（11 - 80）岁。治疗目的为根治性的患者有20例（30个病灶），姑息性的患者有21例（77个病灶）。原发肿瘤为PGL的占63%，PCC的占37%。既往局部治疗方法为手术切除（90%）和经皮消融（19%）。EBRT的适应证为局部控制（66%）、疼痛（22%）或脊髓压迫（12%）。治疗部位包括骨骼（69%）、软组织（30%）和肝脏（1%）。EBRT的中位（范围）剂量为40（6.5 - 70）Gy。使用α/β = 10计算的中位生物等效剂量（BED）为53（9 - 132）。中位随访时间为3.8年（0.04 - 41.5），平均随访时间为9.7年。5年总生存率为65%：根治性治疗患者为79%，姑息性治疗患者为50%（P = 0.028）。所有病灶的5年局部控制率为81%；接受BED≥53的病灶为91%，接受BED < 53的病灶为62%（P = 0.001）。所有11个接受立体定向体部放疗或放射外科治疗的病灶的局部控制时间中位值为3.0（0.2 - 5.4）年。对于有症状的病灶，94%的症状得到改善。没有急性3级及以上与治疗相关的不良事件，包括没有高血压危象。2例患者出现晚期3级及以上不良事件。
EBRT是治疗恶性PGL和PCC的一种有效治疗方式。较高的放疗剂量与更好的局部控制相关。
