Lütgendorf-Caucig Carola, Pelak Maciej, Hug Eugen, Flechl Birgit, Surböck Birgit, Marosi Christine, Mock Ulrike, Zach Leor, Mardor Yael, Furman Orit, Hentschel Harald, Gora Joanna, Fossati Piero, Stock Markus, Graichen Uwe, Klee Sascha, Georg Petra
MedAustron Ion Therapy Center, Wiener Neustadt, Austria.
MedAustron Ion Therapy Center, Wiener Neustadt, Austria; University Clinic for Radiotherapy and Radiation Oncology, Uniklinikum Salzburg, Salzburg, Austria.
Int J Radiat Oncol Biol Phys. 2024 Apr 1;118(5):1206-1216. doi: 10.1016/j.ijrobp.2024.01.007. Epub 2024 Jan 18.
Intracerebral radiation-induced contrast enhancement (RICE) can occur after photon as well as proton beam therapy (PBT). This study evaluated the incidence, characteristics, and risk factors of RICE after PBT delivered to, or in direct proximity to, the brain and its effect on health-related quality of life (HRQoL).
Four hundred twenty-one patients treated with pencil beam scanning PBT between 2017 and 2021 were included. Follow-up included clinical evaluation and contrast-enhanced magnetic resonance imaging at 3, 6, and 12 months after treatment completion and annually thereafter. RICE was graded according to Common Terminology Criteria for Adverse Events version 4, and HRQoL parameters were assessed via European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 questionnaires.
The median follow-up was 24 months (range, 6-54), and median dose to 1% relative volume of noninvolved central nervous system (D1%CNS) was 54.3 Gy relative biologic effectiveness (RBE; range, 30-76 Gy RBE). The cumulative RICE incidence was 15% (n = 63), of which 10.5% (n = 44) were grade 1, 3.1% (n = 13) were grade 2, and 1.4% (n = 6) were grade 3. No grade 4 or 5 events were observed. Twenty-six of 63 RICE (41.3%) had resolved at the latest follow-up. The median onset after PBT and duration of RICE in patients in whom the lesions resolved were 11.8 and 9.0 months, respectively. On multivariable analysis, D1%CNS > 57.6 Gy RBE, previous in-field radiation, and diabetes mellitus were identified as significant risk factors for RICE development. Previous radiation was the only factor influencing the risk of symptomatic RICE. After PBT, general HRQoL parameters were not compromised. In a matched cohort analysis of 54/50 patients with and without RICE, no differences in global health score or functional and symptom scales were seen.
The overall incidence of clinically relevant RICE after PBT is very low and has no significant negative effect on long-term patient QoL.
光子及质子束治疗（PBT）后均可发生脑内辐射诱导的对比增强（RICE）。本研究评估了脑部或其紧邻区域接受PBT后RICE的发生率、特征及危险因素，及其对健康相关生活质量（HRQoL）的影响。
纳入2017年至2021年间接受笔形束扫描PBT治疗的421例患者。随访包括治疗结束后3、6和12个月以及此后每年的临床评估和对比增强磁共振成像。RICE根据不良事件通用术语标准第4版进行分级，HRQoL参数通过欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ）-C30问卷进行评估。
中位随访时间为24个月（范围6 - 54个月），未累及的中枢神经系统1%相对体积的中位剂量（D1%CNS）为54.3 Gy相对生物效应（RBE；范围30 - 76 Gy RBE）。RICE的累积发生率为15%（n = 63），其中10.5%（n = 44）为1级，3.1%（n = 13）为2级，1.4%（n = 6）为3级。未观察到4级或5级事件。63例RICE中有26例（41.3%）在最近一次随访时已消退。病变消退患者的PBT后RICE中位发病时间和持续时间分别为11.8个月和9.0个月。多变量分析显示，D1%CNS > 57.6 Gy RBE、既往野内放疗和糖尿病被确定为RICE发生的显著危险因素。既往放疗是影响有症状RICE风险的唯一因素。PBT后，总体HRQoL参数未受影响。在54/50例有和无RICE患者的配对队列分析中，全球健康评分或功能及症状量表未见差异。
PBT后临床相关RICE的总体发生率非常低，对患者长期生活质量无显著负面影响。
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