Muroi Ai, Mizumoto Masashi, Ishikawa Eiichi, Ihara Satoshi, Fukushima Hiroko, Tsurubuchi Takao, Sakurai Hideyuki, Matsumura Akira
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Ibaraki, Japan.
Childs Nerv Syst. 2020 Mar;36(3):507-512. doi: 10.1007/s00381-019-04420-9. Epub 2019 Nov 14.
Diffuse intrinsic pontine glioma (DIPG) is a type of brain malignancy with a very poor prognosis. Although various radiation and chemotherapy protocols have been attempted, only conventional radiotherapy has yielded improvements in survival. In this study, we aimed to compare proton therapy versus conventional photon radiotherapy in terms of the outcomes of pediatric patients with DIPG.
This retrospective review included 12 pediatric patients with newly diagnosed DIPG who received a total proton therapy dose of 54 Gy (relative biological effectiveness) in 30 fractions at the University of Tsukuba Hospital between 2011 and 2017 (proton group). We additionally reviewed the medical records of 10 patients with DIPG who previously underwent conventional photon radiotherapy at our institute (historical cohort).
The median progression-free survival (PFS) duration was 5 months (range 1-11 months), and the 6-, 12-, and 18-month PFS rates were 50%, 33%, and 25%, respectively. The median overall survival (OS) duration was 9 months (range 4-48 months), and the 6-, 12-, 18-, and 24-month OS rates were 66.8%, 50%, 41%, and 20%, respectively. There were no significant differences in survival between the proton and historical groups (PFS, p = 0.169 and OS, p = 0.16).
Proton therapy was well tolerated by the majority of patients. No severe adverse events, including radiation necrosis, were recorded. Proton therapy did not yield superior survival outcomes vs. conventional photon radiotherapy in patients with DIPG at our institution. Further research is needed to identify the factors associated with better survival in this population.
弥漫性脑桥内在型胶质瘤（DIPG）是一种预后极差的脑恶性肿瘤。尽管尝试了各种放疗和化疗方案，但只有传统放疗在生存率方面取得了改善。在本研究中，我们旨在比较质子治疗与传统光子放疗对小儿DIPG患者的治疗效果。
这项回顾性研究纳入了12例新诊断的小儿DIPG患者，他们于2011年至2017年在筑波大学医院接受了总量为54 Gy（相对生物效应）、分30次的质子治疗（质子组）。我们还回顾了10例先前在我院接受传统光子放疗的DIPG患者的病历（历史队列）。
无进展生存期（PFS）的中位数为5个月（范围1 - 11个月），6个月、12个月和18个月的PFS率分别为50%、33%和25%。总生存期（OS）的中位数为9个月（范围4 - 48个月），6个月、12个月、18个月和24个月的OS率分别为66.8%、50%、41%和20%。质子组与历史组在生存率方面无显著差异（PFS，p = 0.169；OS，p = 0.16）。
大多数患者对质子治疗耐受性良好。未记录到包括放射性坏死在内的严重不良事件。在我院，质子治疗与传统光子放疗相比，并未产生更好的生存结果。需要进一步研究以确定该人群中与更好生存相关的因素。
