Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Int J Radiat Oncol Biol Phys. 2019 Jun 1;104(2):401-408. doi: 10.1016/j.ijrobp.2019.01.095. Epub 2019 Feb 7.
Patients with high-risk neuroblastoma (HR-NBL) require radiation to the primary tumor site and sites of persistent metastatic disease. Proton radiation therapy (PRT) may promote organ sparing, but long-term outcomes have not been studied.
Sequential patients with HR-NBL received PRT: 2160 cGy (relative biological effectiveness) to primary tumor bed and persistent metastatic sites, with 3600 cGy (relative biological effectiveness) to gross residual disease.
From September 2010 through September 2015, 45 patients with HR-NBL received PRT after systemic therapy, primary tumor resection, and high-dose chemotherapy with stem cell rescue. Median age was 46 months at the time of PRT (range, 10 months to 12 years); 23 patients (51%) were male. Primary tumors were adrenal in 40 (89%); 11 (24%) received boost. Ten metastatic sites in 8 patients were radiated. Double scattered proton beams were used for 19 (42%) patients, in combination with x-rays for 2 (5%). The remaining 26 (58%) received pencil beam scanning, available since January 2013. We observed 97% freedom from primary site recurrence at 3, 4, and 5 years. Overall survival rates were 89%, 80%, and 80% and disease-free survival rates were 77%, 70%, and 70%, at 3, 4, and 5 years, respectively. With median follow-up of 48.7 months from diagnosis (range, 11-90 months) for all patients (57.4 months for those alive), 37 (82%) patients are alive, and 32 (71%) are without evidence of disease. One patient experienced locoregional recurrence; the remaining 12 (27%) experienced relapse at distant, nonradiated sites. Acute toxicities during treatment were mainly grade 1. No patient has experienced World Health Organization grade 3 or 4 long-term renal or hepatic toxicity. Pencil beam scanning plans required less planning time and resources than double scattered plans.
We observe excellent outcomes in patients treated with PRT for HR-NBL from 2010 through 2015, with 82% of patients alive and 97% free of primary site recurrence. No patient has experienced long-term renal or liver toxicity. This treatment maximizes normal tissue preservation and is appropriate for this patient population.
高危神经母细胞瘤（HR-NBL）患者需要对原发肿瘤部位和持续转移病灶进行放射治疗。质子放射治疗（PRT）可能促进器官保留，但尚未研究其长期结果。
连续的 HR-NBL 患者接受 PRT：原发肿瘤床和持续转移部位给予 2160 cGy（相对生物效应），大体残留疾病部位给予 3600 cGy（相对生物效应）。
自 2010 年 9 月至 2015 年 9 月，45 例 HR-NBL 患者在全身治疗、原发肿瘤切除和大剂量化疗联合干细胞解救后接受 PRT。PRT 时的中位年龄为 46 个月（范围，10 个月至 12 岁）；23 例（51%）为男性。40 例（89%）的原发肿瘤为肾上腺；11 例（24%）给予了加量照射。8 例患者的 10 个转移部位接受了放射治疗。19 例（42%）患者采用双散射质子束，2 例（5%）采用 X 射线。其余 26 例（58%）采用笔形束扫描，自 2013 年 1 月开始使用。我们观察到 3、4 和 5 年时原发部位无复发率分别为 97%、97%和 97%。3、4 和 5 年的总生存率分别为 89%、80%和 80%，无病生存率分别为 77%、70%和 70%。所有患者（存活患者为 57.4 个月）从诊断到中位随访时间为 48.7 个月（范围，11-90 个月），37 例（82%）患者存活，32 例（71%）患者无疾病证据。1 例患者发生局部区域复发；其余 12 例（27%）在未照射的远处部位复发。治疗期间的急性毒性主要为 1 级。无患者出现世界卫生组织 3 级或 4 级的长期肾或肝毒性。笔形束扫描计划比双散射计划需要更少的计划时间和资源。
我们观察到 2010 年至 2015 年接受 PRT 治疗的 HR-NBL 患者取得了良好的结果，82%的患者存活，97%的患者无原发部位复发。无患者出现长期肾或肝毒性。这种治疗最大限度地保留了正常组织，适合这一患者人群。
