Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany.
Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany.
Radiother Oncol. 2022 Jul;172:54-64. doi: 10.1016/j.radonc.2022.05.005. Epub 2022 May 11.
Proton beam radiotherapy (PRT) is used in the treatment of low-grade glioma (LGG) to mitigate long-term sequelae. Following PRT, increased rates of radiation-induced contrast enhancements (RICE) are suspected but poorly understood.
We analyzed consecutive 227 patients (42 children and 185 adults) treated with PRT (54 Gy RBE) for LGG from 2010 to 2020 and followed with serial clinical exams and magnetic resonance imaging for in median 5.6 years.
Tumors were graded WHO 1 in a minority (n = 22, 12%) of adults, but a majority of children (n = 29, 69%). In contrast, tumors were graded WHO 2 in the majority (n = 160, 87%) of adults and a minority of children (n = 10, 24%). Five-year overall survival following PRT was 81% in adults and 91% in children. The risk of RICE was 5-fold more frequent in adults (25%) vs. children (5%; p = 0.0043). In children and adults, RICE were symptomatic in 50% and 55% (n = 1 and 26) of cases with CTCAE grade 0 in 47% (n = 23), grade 1 in 25% (n = 12), 0% grade 2 (n = 0) and 29% grade 3 (n = 14), respectively. In adults, RICE risk was associated to WHO grading (8% in WHO grade 1 vs. 24% in WHO grade 2, p = 0.026), independent of age (p = 0.44) and irradiation dose (p = 0.005), but not independent of IDH mutational status.
These data demonstrate effectiveness of PRT for LGG in both children and adults. The RICE risk is lower in children which are a main target group for PRT and differs with WHO grading.
质子束放射治疗（PRT）用于治疗低级别胶质瘤（LGG）以减轻长期后遗症。在 PRT 后，怀疑会增加放射性对比增强（RICE）的发生率，但了解甚少。
我们分析了 2010 年至 2020 年期间连续 227 例接受 PRT（54 GyRBE）治疗的 LGG 患者（42 例儿童和 185 例成人）的资料，中位随访时间为 5.6 年，随访内容包括定期临床检查和磁共振成像。
成人中少数（n=22，12%）肿瘤分级为 WHO 1，而多数（n=29，69%）为儿童。相比之下，多数（n=160，87%）成人和少数（n=10，24%）儿童肿瘤分级为 WHO 2。PRT 后成人的 5 年总生存率为 81%，儿童为 91%。成人的 RICE 风险是儿童的 5 倍（25% vs. 5%；p=0.0043）。在儿童和成人中，RICE 的症状发生率分别为 50%和 55%（n=1 和 26），CTCAE 分级分别为 47%（n=23）为 0 级，25%（n=12）为 1 级，0 级为 0%（n=0）和 29%（n=14）为 3 级。在成人中，RICE 风险与 WHO 分级相关（WHO 1 级为 8%，WHO 2 级为 24%，p=0.026），与年龄（p=0.44）和照射剂量（p=0.005）无关，但与 IDH 突变状态无关。
这些数据表明 PRT 对儿童和成人 LGG 均有效。RICE 的风险在儿童中较低，儿童是 PRT 的主要目标人群，且 RICE 风险与 WHO 分级不同。
