Vázquez Miriam, Baust Katja, Ilundain Amaia, Leiser Dominic, Bachtiary Barbara, Pica Alessia, Kliebsch Ulrike L, Calaminus Gabriele, Weber Damien C
Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.
Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany.
Int J Part Ther. 2023 Oct 25;10(2):73-84. doi: 10.14338/IJPT-23-00010.1. eCollection 2023 Fall.
To assess clinical outcomes of adolescents and young adults (AYAs) with head and neck sarcomas (HNSs) treated with pencil beam scanning proton therapy (PBSPT) and to report quality of life (QoL).
Twenty-eight AYAs (aged 15 to 39 years) with HNS treated between January 2001 and July 2022 at our institution were included. The median age was 21.6 years. Rhabdomyosarcoma (39.3%), Ewing sarcoma (17.9%), chondrosarcoma (14.3%), and osteosarcoma (14.3%) were the most frequent diagnoses. Three (10.7%) patients were metastatic before PBSPT and 13 (46.4%) patients had a tumor with intracranial extension. The median total radiation dose was 63 GyRBE (range, 45 to 74 GyRBE). Thirteen (46.4%) patients received concomitant chemotherapy. Toxicity was reported according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 (US National Institutes of Health, Bethesda, Maryland). Survival was estimated using the Kaplan-Meier method. QoL was assessed using a PEDQOL (Pediatric Quality of Life Questionnaire) questionnaire. Self-reported outcomes were assessed using institutional questionnaires.
With a median follow-up of 57 months (range, 3.7 to 243 months), 5 patients (17.8%) had local failure (LF) only, 2 (7.1%) experienced distant failure (DF) only, and 2 (7.1%) had LF and DF. The estimated 5-year local control (LC) and distant control (DC) rates were 71.8% and 80.5%, respectively. The median times to LF and DF were 13.4 and 22.2 months, respectively. Four (14.3%) patients died, all but one from their HNS. Estimated 5-year overall survival was 90.7%. Six (21.4%) patients developed nonocular grade ≥3 toxicity, which consisted of otitis media (n = 2), hearing impairment (n = 2), osteoradionecrosis (n = 1), and sinusitis (n = 1). Four (14.3%) patients developed cataracts that required surgery. The 5-year freedom from nonocular grade 3 toxicity was 91.1%. No grade 4 or higher toxicity was observed. Adolescents rated their quality of life before treatment worse than their parents did.
Excellent outcomes with acceptable late-toxicity rates were observed for AYAs with HNS after PBSPT.
评估接受笔形束扫描质子治疗（PBSPT）的青少年和青年（AYA）头颈部肉瘤（HNS）患者的临床结局，并报告生活质量（QoL）。
纳入2001年1月至2022年7月在本机构接受治疗的28例AYA（年龄15至39岁）HNS患者。中位年龄为21.6岁。横纹肌肉瘤（39.3%）、尤因肉瘤（17.9%）、软骨肉瘤（14.3%）和骨肉瘤（14.3%）是最常见的诊断类型。3例（10.7%）患者在PBSPT前已发生转移，13例（46.4%）患者的肿瘤有颅内扩展。中位总辐射剂量为63 GyRBE（范围，45至74 GyRBE）。13例（46.4%）患者接受了同步化疗。根据不良事件通用术语标准（CTCAE）第5.0版（美国国立卫生研究院，马里兰州贝塞斯达）报告毒性反应。采用Kaplan-Meier方法估计生存率。使用儿童生活质量问卷（PEDQOL）评估生活质量。使用机构问卷评估自我报告的结局。
中位随访57个月（范围，3.7至243个月），5例（17.8%）患者仅发生局部失败（LF），2例（7.1%）仅发生远处失败（DF），2例（7.1%）同时发生LF和DF。估计5年局部控制（LC）率和远处控制（DC）率分别为71.8%和80.5%。至LF和DF的中位时间分别为13.4个月和22.2个月。4例（14.3%）患者死亡，除1例死于其他原因外，其余均死于HNS。估计5年总生存率为90.7%。6例（21.4%）患者发生非眼部3级及以上毒性反应，包括中耳炎（n = 2）、听力障碍（n = 2）、放射性骨坏死（n = 1）和鼻窦炎（n = 1）。4例（14.3%）患者发生需要手术的白内障。5年无非眼部3级毒性反应的发生率为91.1%。未观察到4级或更高等级的毒性反应。青少年对治疗前生活质量的评分低于其父母。
PBSPT治疗后，AYA-HNS患者取得了优异的结局，晚期毒性率可接受。
