Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
J Neurooncol. 2023 May;162(3):489-501. doi: 10.1007/s11060-022-04217-y. Epub 2023 Jan 4.
Proton beam radiotherapy (PRT) has been demonstrated to improve neurocognitive sequelae particularly. Nevertheless, following PRT, increased rates of radiation-induced contrast enhancements (RICE) are feared. How safe and effective is PRT for IDH-mutated glioma WHO grade 2 and 3?
We analyzed 194 patients diagnosed with IDH-mutated WHO grade 2 (n = 128) and WHO grade 3 (n = 66) glioma who were treated with PRT from 2010 to 2020. Serial clinical and imaging follow-up was performed for a median of 5.1 years.
For WHO grade 2, 61% were astrocytoma and 39% oligodendroglioma while for WHO grade 3, 55% were astrocytoma and 45% oligodendroglioma. Median dose for IDH-mutated glioma was 54 Gy(RBE) [range 50.4-60 Gy(RBE)] for WHO grade 2 and 60 Gy(RBE) [range 54-60 Gy(RBE)] for WHO grade 3. Five year overall survival was 85% in patients with WHO grade 2 and 67% in patients with WHO grade 3 tumors. Overall RICE risk was 25%, being higher in patients with WHO grade 2 (29%) versus in patients with WHO grade 3 (17%, p = 0.13). RICE risk increased independent of tumor characteristics with older age (p = 0.017). Overall RICE was symptomatic in 31% of patients with corresponding CTCAE grades as follows: 80% grade 1, 7% grade 2, 13% grade 3, and 0% grade 3 + . Overall need for RICE-directed therapy was 35%.
These data demonstrate the effectiveness of PRT for IDH-mutated glioma WHO grade 2 and 3. The RICE risk differs with WHO grading and is higher in older patients with IDH-mutated Glioma WHO grade 2 and 3.
质子束放疗（PRT）已被证明可以改善神经认知后遗症，特别是在这方面。然而，PRT 后，人们担心会增加放射性对比增强（RICE）的发生率。对于 IDH 突变型胶质母细胞瘤 WHO 2 级和 3 级，PRT 的安全性和有效性如何？
我们分析了 194 例 2010 年至 2020 年接受 PRT 治疗的 IDH 突变型 WHO 2 级（n=128）和 WHO 3 级（n=66）胶质瘤患者。中位随访时间为 5.1 年。
对于 WHO 2 级，61%为星形细胞瘤，39%为少突胶质细胞瘤；对于 WHO 3 级，55%为星形细胞瘤，45%为少突胶质细胞瘤。IDH 突变型胶质瘤的中位剂量为 54 Gy（RBE）[范围 50.4-60 Gy（RBE）]，用于 WHO 2 级，60 Gy（RBE）[范围 54-60 Gy（RBE）]，用于 WHO 3 级。WHO 2 级患者的 5 年总生存率为 85%，WHO 3 级患者为 67%。总体 RICE 风险为 25%，在 WHO 2 级患者中为 29%，在 WHO 3 级患者中为 17%（p=0.13）。RICE 风险增加与肿瘤特征无关，与年龄较大有关（p=0.017）。总体而言，有 31%的 RICE 患者出现症状，相应的 CTCAE 分级如下：80%为 1 级，7%为 2 级，13%为 3 级，0%为 3 级+。总体上需要进行 RICE 导向治疗的患者有 35%。
这些数据表明 PRT 对 IDH 突变型胶质母细胞瘤 WHO 2 级和 3 级有效。RICE 风险因 WHO 分级而异，IDH 突变型 WHO 2 级和 3 级胶质瘤年龄较大的患者风险更高。
