Kroeze Stephanie G C, Mackeprang Paul-Henry, De Angelis Claudio, Pica Alessia, Bachtiary Barbara, Kliebsch Ulrike L, Weber Damien C
Center for Proton Therapy, Paul Scherrer Institute, Forschungstrasse 111, 5232 Villigen, Switzerland.
Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, Switzerland.
Cancers (Basel). 2021 Sep 29;13(19):4892. doi: 10.3390/cancers13194892.
Proton therapy (PT) is delivered to complex brain tumors to obtain an optimal curative treatment with limited toxicity. Value-based oncological medicine is increasingly important, particularly when long-term survival is to be expected. This study aims to evaluate health-related quality of life (HRQOL) and patient reported outcomes (PROs) in patients treated with PT for brain tumors. Adult patients with brain tumors treated with PT filled out the EORTC-QLQ-C30 and BN20 questionnaires up to three years following PT. Toxicity was scored using the CTCAE v4.03. QoL and PRO were correlated to clinical factors. Three-year overall survival, distant brain control and local control rates were 98%, 97% and 84%, respectively. No ≥G3 acute toxicity was observed. Late PT-related ≥G3 severe toxicity occurred in seven patients (5.7%). Lower global QoL scores after PT were significantly correlated to low Karnofsky performance status (KPS) before PT ( = 0.001), surgical complications before PT ( = 0.04) and progressive disease ( = 0.017). A low QLQ-30 summary score at one year follow-up was correlated to sex ( = 0.015), low KPS before PT ( < 0.001), and central nervous system symptoms before PT ( = 0.018). Reported QLQ-BN20 neurological symptoms were correlated to lower KPS at baseline ( < 0.001) and surgical complications before PT ( = 0.03). PT-related toxicity only influenced reported symptoms directly following PT, but not QoL. Although global QoL temporarily decreased after treatment, it improved again from one year onwards. Global QoL and reported symptoms over time were not correlated with the proton therapy and were more related to preexisting symptoms and progressive disease. This study assists in improving patient support in patients with brain tumors receiving PT.
质子治疗（PT）用于治疗复杂的脑肿瘤，以在毒性有限的情况下获得最佳的治愈性治疗。基于价值的肿瘤医学日益重要，尤其是在预期长期生存的情况下。本研究旨在评估接受PT治疗脑肿瘤患者的健康相关生活质量（HRQOL）和患者报告结局（PROs）。接受PT治疗的成年脑肿瘤患者在PT后长达三年的时间里填写了EORTC-QLQ-C30和BN20问卷。使用CTCAE v4.03对毒性进行评分。生活质量和患者报告结局与临床因素相关。三年总生存率、远处脑控制率和局部控制率分别为98%、97%和84%。未观察到≥G3级急性毒性。7例患者（5.7%）发生了与PT相关的晚期≥G3级严重毒性。PT后较低的总体生活质量评分与PT前较低的卡诺夫斯基功能状态（KPS）（P = 0.001）、PT前的手术并发症（P = 0.04）和疾病进展（P = 0.017）显著相关。随访一年时较低的QLQ-30总结评分与性别（P = 0.015）、PT前较低的KPS（P < 0.001）以及PT前的中枢神经系统症状（P = 0.018）相关。报告的QLQ-BN20神经症状与基线时较低的KPS（P < 0.001）和PT前的手术并发症（P = 0.03）相关。与PT相关的毒性仅在PT后直接影响报告的症状，而不影响生活质量。尽管治疗后总体生活质量暂时下降，但从一年起又有所改善。总体生活质量和随时间报告的症状与质子治疗无关，而更多地与既往症状和疾病进展有关。本研究有助于改善接受PT治疗的脑肿瘤患者的患者支持。
