Bavle Abhishek, Srinivasan Anand, Choudhry Farooq, Anderson Michael, Confer Michael, Simpson Hilarie, Gavula Theresa, Thompson J Spencer, Clifton Shari, Gross Naina L, McNall-Knapp Rene
Children's Blood and Cancer Center, Dell Children's Medical Center of Central Texas, Toronto, Canada.
Blood and Marrow Transplant Program, Hospital for Sick Children, Toronto, Canada.
Neurooncol Pract. 2020 Sep 28;8(1):31-39. doi: 10.1093/nop/npaa061. eCollection 2021 Feb.
The aim of our study is to determine the incidence, timing, and risk factors for cerebral vasculopathy after cranial proton and photon radiation for pediatric brain tumors.
We performed a single-institution retrospective review of a cohort of children treated with proton radiation for brain tumors. MRA and/or MRI were reviewed for evidence of cerebral vascular stenosis and infarcts. Twenty-one similar studies (17 photon, 4 proton) were identified by systematic literature review.
For 81 patients with median follow-up of 3 years, the rates of overall and severe vasculopathy were 9.9% and 6.2% respectively, occurring a median of 2 years post radiation. Dose to optic chiasm greater than 45 Gy and suprasellar location were significant risk factors. Results were consistent with 4 prior proton studies (752 patients) that reported incidence of 5% to 6.7%, 1.5 to 3 years post radiation. With significantly longer follow-up (3.7-19 years), 9 studies (1108 patients) with traditional photon radiation reported a higher rate (6.3%-20%) and longer time to vasculopathy (2-28 years). Significant risk factors were neurofibromatosis type 1 (NF-1; rate 7.6%-60%) and suprasellar tumors (9%-20%). In 10 studies with photon radiation (1708 patients), the stroke rate was 2% to 18.8% (2.3-24 years post radiation).
Childhood brain tumor survivors need screening for vasculopathy after cranial radiation, especially with higher dose to optic chiasm, NF-1, and suprasellar tumors. Prospective studies are needed to identify risk groups, and ideal modality and timing, for screening of this toxicity.
我们研究的目的是确定小儿脑肿瘤接受头颅质子和光子放疗后脑血管病变的发生率、发生时间及危险因素。
我们对在本机构接受质子放疗的脑肿瘤患儿队列进行了单机构回顾性研究。对MRA和/或MRI进行评估，以寻找脑血管狭窄和梗死的证据。通过系统文献回顾确定了21项类似研究（17项光子放疗研究，4项质子放疗研究）。
81例患者的中位随访时间为3年，总体血管病变和严重血管病变的发生率分别为9.9%和6.2%，中位发生时间为放疗后2年。视交叉剂量大于45 Gy和鞍上部位是显著的危险因素。结果与之前4项质子放疗研究（752例患者）一致，这些研究报告放疗后1.5至3年的发生率为5%至6.7%。随访时间显著更长（3.7 - 19年）的9项传统光子放疗研究（1108例患者）报告了更高的发生率（6.3% - 20%）和更长的血管病变发生时间（2 - 28年）。显著的危险因素是1型神经纤维瘤病（NF - 1；发生率7.6% - 60%）和鞍上肿瘤（9% - 20%）。在10项光子放疗研究（1708例患者）中，中风发生率为2%至18.8%（放疗后2.3 - 24年）。
儿童脑肿瘤幸存者在头颅放疗后需要筛查血管病变，尤其是对视交叉剂量较高、患有NF - 1和鞍上肿瘤的患者。需要进行前瞻性研究以确定筛查这种毒性的风险群体、理想方式和时间。
