Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Pract Radiat Oncol. 2022 Mar-Apr;12(2):155-162. doi: 10.1016/j.prro.2021.10.011. Epub 2021 Dec 17.
Limited prospective information regarding acute toxicity in pediatric patients receiving proton therapy (PT) exists. In this study, Pediatric Proton Consortium Registry (PPCR) data was analyzed for factors associated with development of acute toxicity in children receiving passively scattered or pencil beam scanning PT.
Pediatric patients treated with PT and enrolled on the PPCR from 2016 to 2017 at 7 institutions were included. Data were entered on presence versus absence of acute general, cardiac, endocrine, eye, gastrointestinal, genitourinary, hematologic, mouth, musculoskeletal, neurologic, psychological, respiratory, and skin toxicities before (baseline) and at the end of PT (acute). Associations between patient and treatment variables with development of acute toxicity were assessed with multivariable modeling.
Of 422 patients included, PT technique was passively scattered in 241 (57%), pencil beam scanning in 180 (43%), and missing in 1 (<1%) patient. Median age was 9.9 years. Daily anesthesia for treatment was used in 169 (40%). Treatments were categorized as craniospinal irradiation (CSI; n = 100, 24%), focal central nervous system PT (n = 157, 38%), or body PT (n = 158, 38%). Passively scattered PT was associated with increased risk of hematologic toxicity compared with pencil beam scanning PT (odds ratio [OR]: 3.03; 95% confidence interval [CI], 1.38-6.70; P = .006). There were no other differences toxicities between PT techniques. Uninsured patients had increased risk of GI (OR: 2.71; 95% CI, 1.12-6.58; P = .027) and hematologic toxicity (OR: 10.67; 95% CI, 2.68-42.46; P <.001). Patients receiving concurrent chemotherapy were more likely to experience skin (OR: 2.45; 95% CI, 1.23-4.88; P = .011), hematologic (OR: 2.87; 95% CI, 1.31-6.25; P = .008), GI (OR: 2.37; 95% CI, 1.33-4.21; P = .003), and mouth toxicities (OR: 2.03; 95% CI, 1.10-3.73; P = .024). Patients receiving 49 to 55 Gy were more likely to experience skin (OR: 2.18; 95% CI, 1.06-4.44; P = .033) toxicity than those receiving <49 Gy.
The PPCR registry highlights broad differences in acute toxicity rates in children receiving PT, and identifies opportunities for improvements in prevention, monitoring, and treatment of toxicities.
目前关于接受质子治疗（PT）的儿科患者急性毒性的前瞻性信息有限。在这项研究中，分析了儿科质子联合研究组（PPCR）的数据，以确定与接受被动散射或笔形束扫描 PT 的儿童发生急性毒性相关的因素。
纳入了 2016 年至 2017 年在 7 家机构接受 PT 治疗并在 PPCR 登记的儿科患者。记录了基线和 PT 结束时（急性）患者存在或不存在一般、心脏、内分泌、眼睛、胃肠道、泌尿生殖、血液、口腔、肌肉骨骼、神经、心理、呼吸和皮肤毒性的情况。使用多变量模型评估患者和治疗变量与急性毒性发展之间的关系。
在 422 名患者中，PT 技术为被动散射的有 241 例（57%），笔形束扫描的有 180 例（43%），1 例（<1%）缺失。中位年龄为 9.9 岁。169 例（40%）患者接受每日麻醉治疗。治疗分为全脑脊髓照射（CSI；n=100，24%）、局灶性中枢神经系统 PT（n=157，38%）或体部 PT（n=158，38%）。与笔形束扫描 PT 相比，接受被动散射 PT 的患者血液毒性风险增加（比值比 [OR]：3.03；95%置信区间 [CI]，1.38-6.70；P=0.006）。两种 PT 技术之间没有其他毒性差异。未参保患者胃肠道（OR：2.71；95% CI，1.12-6.58；P=0.027）和血液毒性（OR：10.67；95% CI，2.68-42.46；P<.001）的风险增加。同时接受化疗的患者皮肤（OR：2.45；95% CI，1.23-4.88；P=0.011）、血液（OR：2.87；95% CI，1.31-6.25；P=0.008）、胃肠道（OR：2.37；95% CI，1.33-4.21；P=0.003）和口腔毒性（OR：2.03；95% CI，1.10-3.73；P=0.024）的风险增加。接受 49 至 55 Gy 剂量的患者发生皮肤毒性的风险（OR：2.18；95% CI，1.06-4.44；P=0.033）高于接受<49 Gy 剂量的患者。
PPCR 登记处强调了接受 PT 的儿科患者急性毒性发生率的广泛差异，并确定了在预防、监测和治疗毒性方面需要改进的机会。
