Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida.
Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):854-859. doi: 10.1016/j.ijrobp.2018.03.027. Epub 2018 Mar 29.
To estimate the rate of and identify risk factors for vasculopathy after proton therapy in pediatric patients with central nervous system and skull base tumors.
Between 2006 and 2015, 644 pediatric patients with central nervous system and skull base tumors were treated with proton therapy at a single institution. The 3 most common histologies were craniopharyngioma (n = 135), ependymoma (n = 135), and low-grade glioma (n = 131). The median age was 7.6 years (range, 0.7-21.8 years), and the median prescribed dose was 54 cobalt gray equivalent (CGE) (range, 25.2-75.6 CGE). For this analysis, vasculopathy included asymptomatic vessel narrowing identified on imaging, transient ischemic attacks, and cerebrovascular accidents. Serious vasculopathy was defined as events resulting in permanent neurologic complications or requiring revascularization surgery. Multivariate logistic regression (MVA) was used to assess predictors of toxicity. Variables examined included age, neurofibromatosis, extent of surgical resection, chemotherapy, postoperative stroke, total prescribed dose, and dose delivered to the optic nerves, chiasm, and hypothalamus.
With a median follow-up of 3.0 years (range, 0.1-9.6 years), the 3-year cumulative rates of any vasculopathy and serious vasculopathy were 6.4% and 2.6%, respectively. Seven children (1.2%) experienced a stroke with permanent neurologic deficits; 4 required revascularization surgery. On MVA, maximum dose to the optic chiasm ≥ 54 CGE was significantly associated with the development of any vasculopathy (13.1% vs 2.2%; P < .001); age < 5 years was also significant (8.4% vs 5.4%; P < .01). On MVA, maximum dose to the optic chiasm ≥ 54 CGE also predicted serious vasculopathy (3.8% vs 1.7%; P < .05).
Childhood cancer survivors are at risk of vasculopathy after cranial radiation therapy. Young children and those receiving ≥54 CGE to the chiasm are at an increased risk of this toxicity. These findings suggest appropriate follow-up and screening are important in this population.
评估质子治疗儿童中枢神经系统和颅底肿瘤后血管病变的发生率，并确定其危险因素。
在 2006 年至 2015 年间，一家机构对 644 例中枢神经系统和颅底肿瘤患儿进行了质子治疗。最常见的三种组织学类型为颅咽管瘤（n=135）、室管膜瘤（n=135）和低级别胶质瘤（n=131）。中位年龄为 7.6 岁（范围：0.7-21.8 岁），中位处方剂量为 54 钴Gray 等效（CGE）（范围：25.2-75.6 CGE）。在本分析中，血管病变包括影像学检查发现的无症状血管狭窄、短暂性脑缺血发作和脑血管意外。严重血管病变定义为导致永久性神经并发症或需要血管重建手术的事件。多变量逻辑回归（MVA）用于评估毒性的预测因素。检查的变量包括年龄、神经纤维瘤病、手术切除范围、化疗、术后中风、总处方剂量以及视神经、视交叉和下丘脑的剂量。
中位随访 3.0 年（范围：0.1-9.6 年），3 年累积任何血管病变和严重血管病变的发生率分别为 6.4%和 2.6%。7 名儿童（1.2%）发生永久性神经功能缺损的中风，4 名需要血管重建手术。在 MVA 中，视交叉最大剂量≥54 CGE 与任何血管病变的发生显著相关（13.1% vs 2.2%；P<0.001）；年龄<5 岁也有显著意义（8.4% vs 5.4%；P<0.01）。在 MVA 中，视交叉最大剂量≥54 CGE 也预测严重血管病变（3.8% vs 1.7%；P<0.05）。
颅放疗后儿童癌症幸存者存在血管病变的风险。接受≥54 CGE 视交叉剂量的幼儿和儿童发生这种毒性的风险增加。这些发现表明在该人群中进行适当的随访和筛查很重要。
