Badiyan Shahed N, Ulmer Stephan, Ahlhelm Frank J, Fredh Anna S M, Kliebsch Ulrike, Calaminus Gabriele, Bolsi Alessandra, Albertini Francesca, Leiser Dominic, Timmermann Beate, Malyapa Robert S, Schneider Ralf, Lomax Antony J, Weber Damien C
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Medical Radiological Institute, Zurich, Switzerland.
Int J Part Ther. 2017 Spring;3(4):450-460. doi: 10.14338/IJPT-16-00031.1. Epub 2017 Jul 11.
We assessed clinical and radiologic outcomes in adults and children with low-grade glioma (LGG) of the brain treated with pencil-beam scanning (PBS) proton therapy (PT).
Between 1997 and 2014, 28 patients were treated with PBS PT, 20 (71%) of whom were younger than 18 years. Median age at start of PT was 12.3 years (range, 2.2-53.0 years). Nine patients (32%) underwent at least a subtotal resection; 12 (43%) underwent biopsy; and 7 (25%) were diagnosed radiographically. Twelve patients (43%) had grade II and 9 (32%) had grade I gliomas. Eleven patients (39%) received chemotherapy before PT. A median dose of 54 Gy (relative biologic effectiveness) was administered. Radiologic response to PT was determined using the Response Evaluation Criteria in Solid Tumors (RECIST). Eight domains of quality of life (QoL) for 16 pediatric patients were assessed prospectively by patients' parents using the pediatric QoL proxy questionnaire. Progression-free survival and overall survival (OS) were estimated by the Kaplan-Meier method. Median follow-up was 42.1 months for living patients.
Ten patients (36%) developed local, clinical failure. Three patients (11%) died, all of tumor progression. Radiographic tumor response by RECIST was evaluable in 11 patients: 9 (82%) with stable disease, 1 (9%) with partial response, and 1 (9%) with complete response to PT. Three-year OS and progression-free survival were 83.4% and 56.0%, respectively. No ≥ grade III acute toxicities were observed. Grade III, late radiation necrosis developed in 1 patient (4%). No appreciable change in pediatric QoL proxy scores in children was noted in any of the 8 domains at any time point.
Treatment with PBS PT is effective for LGG, with minimal acute toxicity and, in children, no appreciable decline in QoL. More patients and longer follow-up are needed to determine the long-term efficacy and toxicity of PT for LGG.
我们评估了采用笔形束扫描（PBS）质子治疗（PT）的成人大脑低级别胶质瘤（LGG）和儿童大脑低级别胶质瘤患者的临床和放射学结局。
1997年至2014年期间，28例患者接受了PBS PT治疗，其中20例（71%）年龄小于18岁。PT开始时的中位年龄为12.3岁（范围2.2 - 53.0岁）。9例患者（32%）至少接受了次全切除术；12例（43%）接受了活检；7例（25%）通过影像学诊断。12例患者（43%）患有II级胶质瘤，9例（32%）患有I级胶质瘤。11例患者（39%）在PT前接受了化疗。给予的中位剂量为54 Gy（相对生物效应）。使用实体瘤疗效评价标准（RECIST）确定对PT的放射学反应。16例儿科患者的8个生活质量（QoL）领域由患者父母使用儿科QoL代理问卷进行前瞻性评估。采用Kaplan-Meier方法估计无进展生存期和总生存期（OS）。存活患者的中位随访时间为42.1个月。
10例患者（36%）出现局部临床失败。3例患者（11%）死亡，均死于肿瘤进展。11例患者的RECIST放射学肿瘤反应可评估：9例（82%）疾病稳定，1例（9%）部分缓解，1例（9%）对PT完全缓解。三年OS和无进展生存期分别为83.4%和56.0%。未观察到≥III级急性毒性反应。1例患者（4%）发生III级迟发性放射性坏死。在任何时间点的8个领域中，均未发现儿科患者的儿科QoL代理评分有明显变化。
PBS PT治疗LGG有效，急性毒性最小，且在儿童中QoL无明显下降。需要更多患者和更长时间的随访来确定PT对LGG的长期疗效和毒性。
