Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China.
The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Radiat Oncol. 2023 Feb 8;18(1):29. doi: 10.1186/s13014-022-02187-z.
High-grade gliomas are the most common intracranial malignancies, and their current prognosis remains poor despite standard aggressive therapy. Charged particle beams have unique physical and biological properties, especially high relative biological effectiveness (RBE) of carbon ion beam might improve the clinical treatment outcomes of malignant gliomas. We systematically reviewed the safety, efficacy, and dosimetry of carbon-ion or proton radiotherapy to treat high-grade gliomas. The protocol is detailed in the online PROSPERO database, registration No. CRD42021258495. PubMed, EMBASE, Web of Science, and The Cochrane Library databases were collected for data analysis on charged particle radiotherapy for high-grade gliomas. Until July 2022, two independent reviewers extracted data based on inclusion and exclusion criteria. Eleven articles were eligible for further analysis. Overall survival rates were marginally higher in patients with the current standard of care than those receiving concurrent intensity-modulated radiotherapy plus temozolomide. The most common side effects of carbon-ion-related therapy were grade 1-2 (such as dermatitis, headache, and alopecia). Long-term toxicities (more than three to six months) usually present as radiation necrosis; however, toxicities higher than grade 3 were not observed. Similarly, dermatitis, headache, and alopecia are among the most common acute side effects of proton therapy treatment. Despite improvement in survival rates, the method of dose-escalation using proton boost is associated with severe brain necrosis which should not be clinically underestimated. Regarding dosimetry, two studies compared proton therapy and intensity-modulated radiation therapy plans. Proton therapy plans aimed to minimize dose exposure to non-target tissues while maintaining target coverage. The use of charged-particle radiotherapy seems to be effective with acceptable adverse effects when used either alone or as a boost. The tendency of survival outcome shows that carbon ion boost is seemingly superior to proton boost. The proton beam could provide good target coverage, and it seems to reduce dose exposure to contralateral organs at risk significantly. This can potentially reduce the treatment-related dose- and volume-related side effects in long-term survivors, such as neurocognitive impairment. High-quality randomized control trials should be conducted in the future. Moreover, Systemic therapeutic options that can be paired with charged particles are necessary.
高级别脑胶质瘤是最常见的颅内恶性肿瘤，尽管采用标准的积极治疗方法，但其预后仍然较差。重离子束具有独特的物理和生物学特性，特别是碳离子束的相对生物学效应（RBE）较高，可能改善恶性脑胶质瘤的临床治疗效果。我们系统地回顾了碳离子或质子放射治疗治疗高级别脑胶质瘤的安全性、有效性和剂量学。该方案在在线 PROSPERO 数据库中详细说明，注册号为 CRD42021258495。收集了 PubMed、EMBASE、Web of Science 和 The Cochrane Library 数据库中有关高级别脑胶质瘤的带电粒子放射治疗的数据。截至 2022 年 7 月，两名独立评审员根据纳入和排除标准提取数据。有 11 篇文章符合进一步分析的条件。与接受同期调强放疗加替莫唑胺治疗的患者相比，接受现行标准治疗的患者的总生存率略高。碳离子相关治疗最常见的副作用是 1-2 级（如皮炎、头痛和脱发）。长期毒性（超过 3 至 6 个月）通常表现为放射性坏死；然而，未观察到 3 级以上的毒性。同样，质子治疗的最常见急性副作用包括皮炎、头痛和脱发。尽管生存率有所提高，但使用质子增敏的剂量递增方法与严重的脑坏死有关，这一点不应在临床上被低估。关于剂量学，有两项研究比较了质子治疗和调强放疗计划。质子治疗计划旨在尽量减少对非靶组织的剂量暴露，同时保持靶区覆盖。单独使用或作为增敏剂使用带电粒子放疗似乎是有效的，且副作用可接受。生存结果的趋势表明，碳离子增敏似乎优于质子增敏。质子束可以提供良好的靶区覆盖，并且似乎可以显著减少对对侧危险器官的剂量暴露。这可能会降低长期幸存者的治疗相关剂量和体积相关副作用，如神经认知障碍。未来应该进行高质量的随机对照试验。此外，还需要与带电粒子相匹配的系统治疗方案。
