99例低级别和间变性胶质瘤患者质子或光子治疗后假性进展的分析
Analysis of pseudoprogression after proton or photon therapy of 99 patients with low grade and anaplastic glioma.
作者信息
Bronk Julianna K, Guha-Thakurta Nandita, Allen Pamela K, Mahajan Anita, Grosshans David R, McGovern Susan L
机构信息
Baylor College of Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
出版信息
Clin Transl Radiat Oncol. 2018 Jan 12;9:30-34. doi: 10.1016/j.ctro.2018.01.002. eCollection 2018 Feb.
BACKGROUND AND PURPOSE
Proton therapy is increasingly used to treat primary brain tumors. There is concern for higher rates of pseudoprogression (PsP) after protons compared to photons. The purposes of this study are to compare the rate of PsP after proton vs. photon therapy for grade II and III gliomas and to identify factors associated with the development of PsP.
MATERIALS AND METHODS
Ninety-nine patients age >18 years with grade II or III glioma treated with photons or protons were retrospectively reviewed. Demographic data, IDH and 1p19q status, and treatment factors were analyzed for association with PsP, progression free survival (PFS), and overall survival (OS).
RESULTS
Sixty-five patients were treated with photons and 34 with protons. Among those with oligodendroglioma, PsP developed in 6/42 photon-treated patients (14.3%) and 4/25 proton-treated patients (16%, p = 1.00). Among those with astrocytoma, PsP developed in 3/23 photon-treated patients (13%) and 1/9 proton-treated patients (11.1%, p = 1.00). There was no difference in PsP rate based on radiation type, radiation dose, tumor grade, 1p19q codeletion, or IDH status. PsP occurred earlier in oligodendroglioma patients treated with protons compared to photons, 48 days vs. 131 days, p < .01. On multivariate analyses, gross total resection (p = .03, HR = 0.48, 95%CI = 0.25-0.93) and PsP (p = .04, HR = 0.22, 95% CI = 0.05-0.91) were associated with better PFS; IDH mutation was associated with better OS (p < .01, HR = 0.22, 95%CI = 0.08-0.65).
CONCLUSIONS
Patients with oligodendroglioma but not astrocytoma develop PsP earlier after protons compared to photons. PsP was associated with better PFS.
背景与目的
质子治疗越来越多地用于治疗原发性脑肿瘤。与光子治疗相比，人们担心质子治疗后假性进展（PsP）的发生率更高。本研究的目的是比较质子治疗与光子治疗后II级和III级胶质瘤的PsP发生率，并确定与PsP发生相关的因素。
材料与方法
回顾性分析了99例年龄>18岁、接受光子或质子治疗的II级或III级胶质瘤患者。分析人口统计学数据、异柠檬酸脱氢酶（IDH）和1p19q状态以及治疗因素与PsP、无进展生存期（PFS）和总生存期（OS）的相关性。
结果
65例患者接受光子治疗，34例接受质子治疗。在少突胶质细胞瘤患者中，42例接受光子治疗的患者中有6例（14.3%）发生PsP，25例接受质子治疗的患者中有4例（16%，p = 1.00）发生PsP。在星形细胞瘤患者中，23例接受光子治疗的患者中有3例（13%）发生PsP，9例接受质子治疗的患者中有1例（11.1%，p = 1.00）发生PsP。基于放疗类型、放疗剂量、肿瘤分级、1p19q共缺失或IDH状态，PsP发生率无差异。与光子治疗相比，质子治疗的少突胶质细胞瘤患者PsP出现得更早，分别为48天和131天，p <.01。多因素分析显示，大体全切（p =.03，HR = 0.48，95%CI = 0.25 - 0.93）和PsP（p =.04，HR = 0.22，95%CI = 0.05 - 0.91）与更好的PFS相关；IDH突变与更好的OS相关（p <.01，HR = 0.22，95%CI = 0.08 - 0.65）。
结论
与光子治疗相比，少突胶质细胞瘤患者质子治疗后PsP出现得更早，而星形细胞瘤患者则不然。PsP与更好的PFS相关。
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