Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Shanghai Cancer Center, Shanghai, China.
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.
Cancer. 2020 Jun 15;126(12):2802-2810. doi: 10.1002/cncr.32828. Epub 2020 Mar 13.
The objective of this study was to evaluate the outcomes of patients with high-grade glioma who received treatment with particle radiotherapy.
Between June 2015 and October 2018, 50 consecutive and nonselected patients with glioblastoma multiforme (n = 34) or anaplastic glioma (n = 16) were treated at the Shanghai Proton and Heavy Ion Center. Twenty-four patients received proton radiotherapy (at a dose of 60 gray-equivalents in 30 daily fractions), and 26 patients received proton radiotherapy plus a carbon-ion radiotherapy (CIRT) boost in various dose-escalating schemes. All patients received temozolomide because of their age or their O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. Progression-free survival (PFS) and overall survival (OS) rates, as well as treatment-induced toxicities, were analyzed.
At a median follow-up of 14.3 months (range, 4.8-39.6 months), the 12-month and 18-month OS rates were 87.8% (95% CI, 77.6%-98.0%) and 72.8% (95% CI, 56.7%-88.9%), respectively, and the 12-month and 18-month PFS rates were 74.2% (95% CI, 60.9%-87.5%) and 59.8% (95% CI, 43.1%-76.5%), respectively. Univariate analyses revealed that age (>50 vs ≤50 years), World Health Organization grade (3 vs 4), and Karnofsky performance status (>80 vs ≤80) were significant prognosticators for OS, and IDH mutation and World Health Organization grade were significant for predicting PFS. Furthermore, MGMT promoter methylation, performance status, and age showed a trend toward predicting PFS. No significant predictive factors for PFS or OS were identified in multivariate analyses. Twenty-nine patients experienced grade 1 treatment-related acute adverse effects, and 11 developed grade 1 (n = 6) or grade 2 (n = 5) late adverse effect of radiation-induced brain necrosis. No grade 3, 4, or 5 toxicities were observed.
Particle radiotherapy produced 18-month OS and PFS rates of 72.8% and 59.8%, respectively, with acceptable adverse effects in patients with high-grade glioma. Particle radiotherapy at a dose ≥60 gray-equivalents appears to be safe and potentially effective.
本研究旨在评估接受粒子放射治疗的高级别胶质瘤患者的治疗结果。
2015 年 6 月至 2018 年 10 月，50 例连续且未经选择的多形性胶质母细胞瘤（n=34）或间变性胶质瘤（n=16）患者在上海质子重离子中心接受治疗。24 例患者接受质子放疗（60 格雷等效剂量，30 天每日分割），26 例患者接受质子放疗联合不同剂量递增方案的碳离子放疗（CIRT）。所有患者因年龄或 O-6-甲基鸟嘌呤-DNA 甲基转移酶（MGMT）启动子甲基化状态接受替莫唑胺治疗。分析无进展生存期（PFS）和总生存期（OS）率以及治疗相关毒性。
中位随访 14.3 个月（范围，4.8-39.6 个月），12 个月和 18 个月的 OS 率分别为 87.8%（95%CI，77.6%-98.0%）和 72.8%（95%CI，56.7%-88.9%），12 个月和 18 个月的 PFS 率分别为 74.2%（95%CI，60.9%-87.5%）和 59.8%（95%CI，43.1%-76.5%）。单因素分析显示，年龄（>50 岁 vs ≤50 岁）、世界卫生组织分级（3 级 vs 4 级）和卡氏功能状态评分（>80 分 vs ≤80 分）是 OS 的显著预后因素，IDH 突变和世界卫生组织分级是预测 PFS 的显著因素。此外，MGMT 启动子甲基化、功能状态和年龄显示出对 PFS 的预测趋势。多因素分析未发现对 PFS 或 OS 有显著预测作用的因素。29 例患者发生 1 级治疗相关急性不良反应，11 例发生 1 级（n=6）或 2 级（n=5）放射性脑坏死的迟发性不良反应。未观察到 3、4 或 5 级毒性。
粒子放疗在高级别胶质瘤患者中产生了 18 个月的 OS 和 PFS 率，分别为 72.8%和 59.8%，具有可接受的不良反应。剂量≥60 格雷等效的粒子放疗似乎是安全且有效的。
