Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Marburg, Marburg, Germany.
Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany.
Strahlenther Onkol. 2022 May;198(5):427-435. doi: 10.1007/s00066-021-01844-8. Epub 2021 Sep 14.
Purpose of this study was to investigate overall survival in recurrent glioblastoma treated with either carbon ion reirradiation or photon reirradiation.
In this retrospective study we evaluated 78 consecutive patients with recurrent IDH (Isocitrate dehydrogenase)-wildtype glioblastoma (38 patients carbon ion re-radiotherapy, 40 patients photon re-radiotherapy) treated with either carbon ion reirradiation or stereotactic photon reirradiation. 45 Gy (RBE; 15 fractions) carbon ion reirradiation (CIRT) or 39 Gy (13 fractions) photon reirradiation (FSRT) was administered, respectively. Overall survival was investigated with respect to histological, clinical, and epidemiological features. Kaplan-Meier and multivariate Cox statistics were calculated. A propensity score-matched analysis of the FSRT and CIRT groups using variables from a validated prognosis score was carried out.
The type of reirradiation (CIRT vs. FSRT) significantly influenced overall survival-8.0 months vs. 6.5 months (univariate: p = 0.046)-and remained an independent prognostic factor in multivariate analysis (p = 0.017). Propensity score-adjusted analysis with CIRT versus FSRT as the dependent variable yielded a significant overall survival advantage for the CIRT group (median OS 8.9 versus 7.2 months, p = 0.041, 1‑year survival 29 versus 10%). Adverse events (AE) were evaluated for both subgroups. For the FSRT group no toxicity ≥ grade 4 occurred. For the CIRT subgroup no grade 5 AE occurred, but 1 patient developed a grade 4 radionecrosis. We encountered 4 grade 3 toxicities. One patient developed a zoster at the trunk, 2 progressed in their paresis, and 1 featured progressive dysesthesia.
In conclusion, carbon ion treatment is a safe and feasible treatment option for recurrent glioblastoma. Due to the retrospective nature of the study and two different dose levels for CIRT or FSRT, the improved outcome in CIRT reirradiation might be an effect of higher biological impact from carbon ions or a simple dose-escalation effect. This hypothesis needs prospective testing in larger patient cohorts. A prospective phase III randomized trial is in preparation at our center.
本研究旨在探讨采用碳离子再放疗或光子再放疗治疗复发性胶质母细胞瘤的总生存率。
在这项回顾性研究中，我们评估了 78 例连续 IDH（异柠檬酸脱氢酶）野生型胶质母细胞瘤患者（38 例接受碳离子再放疗，40 例接受光子再放疗），分别接受 45Gy（RBE；15 个分次）碳离子再放疗（CIRT）或 39Gy（13 个分次）光子再放疗（FSRT）。根据组织学、临床和流行病学特征，研究总生存率。采用 Kaplan-Meier 和多变量 Cox 统计学进行分析。使用经过验证的预后评分中的变量，对 FSRT 和 CIRT 组进行倾向评分匹配分析。
再放疗类型（CIRT 与 FSRT）显著影响总生存率-8.0 个月与 6.5 个月（单变量：p=0.046）-并在多变量分析中仍然是独立的预后因素（p=0.017）。以 CIRT 与 FSRT 作为因变量的倾向评分调整分析显示，CIRT 组的总生存率具有显著优势（中位 OS 8.9 与 7.2 个月，p=0.041，1 年生存率 29 与 10%）。对两个亚组进行了不良事件（AE）评估。FSRT 组无≥4 级毒性反应。CIRT 亚组无 5 级 AE，但 1 例发生 4 级放射性坏死。我们发现 4 例 3 级毒性反应。1 例患者躯干出现带状疱疹，2 例进展为瘫痪，1 例出现进行性感觉异常。
总之，碳离子治疗是复发性胶质母细胞瘤的一种安全可行的治疗选择。由于研究的回顾性性质和 CIRT 或 FSRT 的两种不同剂量水平，CIRT 再放疗的改善结果可能是碳离子更高生物学影响的结果，也可能是单纯的剂量递增效应。这一假设需要在更大的患者队列中进行前瞻性测试。我们中心正在准备一项前瞻性 III 期随机试验。
