儿童和青少年复发性髓母细胞瘤的放射治疗：再次放疗和首次放疗后的生存率

Radiotherapy for Recurrent Medulloblastoma in Children and Adolescents: Survival after Re-Irradiation and First-Time Irradiation.

作者信息

Adolph Jonas E, Fleischhack Gudrun, Tschirner Sebastian, Rink Lydia, Dittes Christine, Mikasch Ruth, Dammann Philipp, Mynarek Martin, Obrecht-Sturm Denise, Rutkowski Stefan, Bison Brigitte, Warmuth-Metz Monika, Pietsch Torsten, Pfister Stefan M, Pajtler Kristian W, Milde Till, Kortmann Rolf-Dieter, Dietzsch Stefan, Timmermann Beate, Tippelt Stephan

机构信息

Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany.

Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45122 Essen, Germany.

出版信息

Cancers (Basel). 2024 May 22;16(11):1955. doi: 10.3390/cancers16111955.

BACKGROUND

Radiotherapy (RT) involving craniospinal irradiation (CSI) is important in the initial treatment of medulloblastoma. At recurrence, the re-irradiation options are limited and associated with severe side-effects.

METHODS

For pre-irradiated patients, patients with re-irradiation (RT2) were matched by sex, histology, time to recurrence, disease status and treatment at recurrence to patients without RT2.

RESULTS

A total of 42 pre-irradiated patients with RT2 were matched to 42 pre-irradiated controls without RT2. RT2 improved the median PFS [21.0 (CI: 15.7-28.7) vs. 12.0 (CI: 8.1-21.0) months] and OS [31.5 (CI: 27.6-64.8) vs. 20.0 (CI: 14.0-36.7) months]. Concerning long-term survival after ten years, RT2 only lead to small improvements in OS [8% (CI: 1.4-45.3) vs. 0%]. RT2 improved survival most without (re)-resection [PFS: 17.5 (CI: 9.7-41.5) vs. 8.0 (CI: 6.6-12.2)/OS: 31.5 (CI: 27.6-NA) vs. 13.3 (CI: 8.1-20.1) months]. In the RT-naïve patients, CSI at recurrence improved their median PFS [25.0 (CI: 16.8-60.6) vs. 6.6 (CI: 1.5-NA) months] and OS [40.2 (CI: 18.7-NA) vs. 12.4 (CI: 4.4-NA) months].

CONCLUSIONS

RT2 could improve the median survival in a matched cohort but offered little benefit regarding long-term survival. In RT-naïve patients, CSI greatly improved their median and long-term survival.

背景

涉及全脑全脊髓照射（CSI）的放射治疗（RT）在髓母细胞瘤的初始治疗中很重要。复发时，再照射的选择有限且伴有严重的副作用。

方法

对于预先接受过照射的患者，将接受再照射（RT2）的患者与未接受RT2的患者按性别、组织学、复发时间、疾病状态和复发时的治疗进行匹配。

结果

共有42例预先接受过照射且接受RT2的患者与42例未接受RT2的预先接受过照射的对照患者相匹配。RT2改善了中位无进展生存期[21.0（95%置信区间：15.7 - 28.7）个月对12.0（95%置信区间：8.1 - 21.0）个月]和总生存期[31.5（95%置信区间：27.6 - 64.8）个月对20.0（95%置信区间：14.0 - 36.7）个月]。关于十年后的长期生存，RT2仅使总生存期有小幅改善[8%（95%置信区间：1.4 - 45.3）对0%]。在未进行（再次）切除的情况下，RT2对生存的改善最为明显[无进展生存期：17.5（95%置信区间：9.7 - 41.5）个月对8.0（95%置信区间：6.6 - 12.2）个月/总生存期：31.5（95%置信区间：27.6 - 无可用数据）个月对13.3（95%置信区间：8.1 - 20.1）个月]。在未接受过放疗的患者中，复发时进行CSI改善了他们的中位无进展生存期[25.0（95%置信区间：16.8 - 60.6）个月对6.6（95%置信区间：1.5 - 无可用数据）个月]和总生存期[40.2（95%置信区间：18.7 - 无可用数据）个月对12.4（95%置信区间：4.4 - 无可用数据）个月]。