Chilukuri Srinivas, Burela Nagarjuna, Uppuluri Ramya, Indumathi D, Nangia Sapna, Panda Pankaj Kumar, Shamurailatpam Dayananda Sharma, Raj Revathi, Raja Thirumalai, Jalali Rakesh
Apollo Proton Cancer Centre, Chennai, India.
Apollo Specialty Hospital, Chennai, India.
JCO Glob Oncol. 2020 Nov;6:1736-1745. doi: 10.1200/GO.20.00319.
Proton beam therapy (PBT) has been a preferred modality in pediatric malignancies requiring radiotherapy. We report our preliminary experience of treating consecutive patients younger than 25 years with image-guided pencil beam scanning PBT from the first and only center on the Indian subcontinent.
Patients were selected for PBT on the basis of a multidisciplinary tumor board decision. Patient demographic data, as well as tumor and treatment-related characteristics of the cohort, were captured. Patient and treatment-related factors and their association with acute toxicities were analyzed using univariable and multivariable analyses.
Forty-seven patients (27 with CNS and 20 with non-CNS tumors) with a median age of 9 years (range, 2-25 years) were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma, and glioma. Seventy-seven percent of patients traveled more than 500 km, and 70% of them lived in metropolitan cities. Forty-nine percent of patients had recurrent disease at presentation, and 15% had received a previous course of radiation. The median dose delivered was 54.8 cobalt gray equivalents (range, 40.0-70.4 cobalt gray equivalents) to a median clinical target volume of 175 mL (range, 18.7-3,083.0 mL), with 34% of patients requiring concurrent chemotherapy (CCT). Acute grade 2 and grade 3 dermatitis, mucositis, and hematologic toxicity was noted in 45% and 2%, 34% and 0%, and 38% and 30% of patients, respectively. Grade 2 fatigue was noted in 26% of patients. On multivariable analysis, for CNS tumors, both CCT and craniospinal irradiation were independently associated with ≥ 2 grade hematologic toxicity, whereas among non-CNS tumors, a clinical target volume > 150 mL was associated with ≥ 2 grade fatigue, head and neck irradiation was associated with ≥ 2 grade mucositis, and CCT was associated with grade ≥ 2 hematologic toxicity.
This study demonstrates safe implementation of a PBT program for children and young adults on the Indian subcontinent. Image-guided pencil beam scanning PBT in judiciously selected patients is feasible and can be delivered with acceptable acute toxicities.
质子束治疗（PBT）一直是儿科恶性肿瘤放疗的首选方式。我们报告了在印度次大陆首个也是唯一的中心，对连续的25岁以下患者进行图像引导笔形束扫描PBT的初步经验。
根据多学科肿瘤委员会的决定选择接受PBT治疗的患者。收集患者的人口统计学数据以及该队列的肿瘤和治疗相关特征。使用单变量和多变量分析来分析患者和治疗相关因素及其与急性毒性的关联。
评估了47例患者（27例中枢神经系统肿瘤患者和20例非中枢神经系统肿瘤患者），中位年龄为9岁（范围2至25岁）。最常见的诊断为室管膜瘤、横纹肌肉瘤和胶质瘤。77%的患者行程超过500公里，其中70%居住在大城市。49%的患者初诊时患有复发性疾病，15%的患者曾接受过放疗。中位给予剂量为54.8钴灰当量（范围40.0至70.4钴灰当量），中位临床靶体积为175毫升（范围18.7至3083.0毫升），34%的患者需要同步化疗（CCT）。分别在45%和2%、34%和0%、38%和30%的患者中观察到急性2级和3级皮炎、粘膜炎和血液学毒性。26%的患者出现2级疲劳。多变量分析显示，对于中枢神经系统肿瘤，CCT和全脑全脊髓照射均与≥2级血液学毒性独立相关，而在非中枢神经系统肿瘤中，临床靶体积>150毫升与≥2级疲劳相关，头颈部照射与≥2级粘膜炎相关，CCT与≥2级血液学毒性相关。
本研究表明在印度次大陆为儿童和青年实施PBT计划是安全可行的。在经过审慎选择的患者中，图像引导笔形束扫描PBT是可行的，并且可以在可接受的急性毒性情况下进行。
