Öztunali Anil, Elsayad Khaled, Scobioala Sergiu, Channaoui Mohammed, Haverkamp Uwe, Grauer Oliver, Sträter Ronald, Brentrup Angela, Stummer Walter, Kerl Kornelius, Eich Hans Theodor
Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany.
Neuro-Oncology Department, University Hospital Muenster, 48149 Muenster, Germany.
Cancers (Basel). 2021 Jan 28;13(3):501. doi: 10.3390/cancers13030501.
: Recent trials with craniospinal irradiation (CSI) via helical Tomotherapy (HT) demonstrated encouraging medulloblastoma results. In this study, we assess the toxicity profile of different radiation techniques and estimate survival rates. : We reviewed the records of 46 patients who underwent irradiation for medulloblastoma between 1999 and 2019 (27 conventional radiotherapy technique (CRT) and 19 HT). Patient, tumor, and treatment characteristics, as well as treatment outcomes-local control rate (LCR), event-free survival (EFS), and overall survival (OS)-were reviewed. Acute and late adverse events (AEs) were evaluated according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. : In total, 43 courses of CSI and three local RT were administered to the 46 patients: 30 were male, the median age was 7 years (range 1-56). A median total RT dose of 55 Gy (range 44-68) and a median CSI dose of 35 Gy (range, 23.4-40) was delivered. During follow-up (median, 99 months), six patients (13%) developed recurrence. The EFS rate after 5 years was 84%. The overall OS rates after 5 and 10 years were 95% and 88%, respectively. There were no treatment-related deaths. Following HT, a trend towards lower grade 2/3 acute upper gastrointestinal ( = 0.07) and subacute CNS ( = 0.05) toxicity rates was detected compared to CRT-group. The risk of late CNS toxicities, mainly grade 2/3, was significantly lower following HT technique ( = 0.003). : CSI via HT is an efficacious treatment modality in medulloblastoma patients. In all, we detected a reduced rate of several acute, subacute, and chronic toxicities following HT compared to CRT.
近期采用螺旋断层放疗（HT）进行颅脊髓照射（CSI）的试验取得了令人鼓舞的髓母细胞瘤治疗效果。在本研究中，我们评估了不同放疗技术的毒性特征并估计了生存率。
我们回顾了1999年至2019年间46例接受髓母细胞瘤放疗患者的记录（27例采用传统放疗技术（CRT），19例采用HT）。对患者、肿瘤及治疗特征，以及治疗结果——局部控制率（LCR）、无事件生存率（EFS）和总生存率（OS）进行了回顾。根据放射治疗肿瘤学组和欧洲癌症研究与治疗组织（RTOG/EORTC）标准评估急性和晚期不良事件（AE）。
46例患者共接受了43个CSI疗程和3个局部放疗疗程：男性30例，中位年龄7岁（范围1 - 56岁）。中位总放疗剂量为55 Gy（范围44 - 68），中位CSI剂量为35 Gy（范围23.4 - 40）。随访期间（中位时间99个月），6例患者（13%）出现复发。5年后EFS率为84%。5年和10年后的总OS率分别为95%和88%。无治疗相关死亡。与CRT组相比，HT治疗后2/3级急性上消化道毒性（P = 0.07）和亚急性中枢神经系统毒性（P = 0.05）发生率有降低趋势。HT技术后晚期中枢神经系统毒性风险（主要为2/3级）显著降低（P = 0.003）。
通过HT进行CSI是髓母细胞瘤患者有效的治疗方式。总体而言，我们发现与CRT相比，HT后多种急性、亚急性和慢性毒性发生率降低。
