1Touro College of Osteopathic Medicine, New York, New York.
Departments of2Radiation Oncology and.
J Neurosurg Pediatr. 2024 Sep 27;34(6):642-648. doi: 10.3171/2024.7.PEDS2429. Print 2024 Dec 1.
In a cohort of patients who were treated with resection and adjuvant radiotherapy (RT) for adamantinomatous craniopharyngioma (ACP), the authors aimed to determine whether gross tumor volume (GTV) at the initiation of RT was associated with the risk of progressive disease (PD) following treatment.
Pediatric and adolescent patients who received surgery and RT for ACP at a single institution from 1998 to 2021 were identified. Univariable Cox regression analyses (UVAs) were performed to assess the association between pre-RT GTV and PD after RT. Multivariable analyses (MVAs) were used to control for potential confounders. Two different endpoints were used to define PD. The first definition was based on radiographic tumor growth, with or without progression of clinical symptoms. The second definition was the requirement for an additional tumor-directed intervention following the completion of RT.
Forty-eight patients were eligible for inclusion. The median age at diagnosis was 7.9 years (range 2.1-17.4 years). All patients were treated with surgery and RT with a median dose of 52.2 Gy (range 45-55.8 Gy) and median GTV of 9.86 cm3 (range 0.7-117.7 cm3). After a median follow-up of 66.4 months, 8 patients experienced PD based on both definitions. The 5-year event-free survival rate was 85.4% (95% CI 74.1%-98.3%). On both UVA and MVA, GTV was significantly associated with an increased likelihood of PD (UVA: HR 1.02, 95% CI 1.00-1.04, p = 0.02; MVA: HR 1.10, 95% CI 1.02-1.19, p = 0.01). However, after exclusion of a single outlier with a GTV of 117.7 cm3 prior to RT (remainder of the cohort: range 0.7-37.3 cm3), a second analysis identified no significant association between GTV and PD (UVA: HR 1.03, 95% CI 0.96-1.10, p = 0.4; MVA: HR 1.06, 95% CI 0.96-1.17, p = 0.24).
The authors conclude that for most children and adolescents with ACP, the GTV at the initiation of RT is not associated with the risk of PD. This finding may influence surgical practice, because it suggests that aggressive tumor debulking for the purpose of improving the efficacy of RT may not be necessary. In the case of giant tumors, however, novel strategies may be needed for tumor control.
在接受切除术和辅助放疗 (RT) 治疗造釉细胞瘤的患者队列中，作者旨在确定 RT 起始时的大体肿瘤体积 (GTV) 是否与治疗后进展性疾病 (PD) 的风险相关。
从 1998 年至 2021 年，在一家机构接受手术和 RT 治疗造釉细胞瘤的儿科和青少年患者被确定。进行单变量 Cox 回归分析 (UVAs) 以评估 RT 前 GTV 与 RT 后 PD 之间的关联。多变量分析 (MVAs) 用于控制潜在的混杂因素。使用两种不同的终点来定义 PD。第一个定义基于放射学肿瘤生长，无论是否伴有临床症状的进展。第二个定义是在 RT 完成后需要进行额外的肿瘤定向干预。
48 名患者符合纳入标准。诊断时的中位年龄为 7.9 岁（范围 2.1-17.4 岁）。所有患者均接受手术和 RT 治疗，中位剂量为 52.2 Gy（范围 45-55.8 Gy），中位 GTV 为 9.86 cm3（范围 0.7-117.7 cm3）。中位随访 66.4 个月后，根据两种定义，8 名患者出现 PD。5 年无事件生存率为 85.4%（95%CI 74.1%-98.3%）。在 UVA 和 MVA 上，GTV 均与 PD 发生的可能性增加显著相关（UVA：HR 1.02，95%CI 1.00-1.04，p=0.02；MVA：HR 1.10，95%CI 1.02-1.19，p=0.01）。然而，在排除 RT 前 GTV 为 117.7 cm3 的单个异常值（队列其余部分：范围 0.7-37.3 cm3）后，第二次分析未发现 GTV 与 PD 之间存在显著关联（UVA：HR 1.03，95%CI 0.96-1.10，p=0.4；MVA：HR 1.06，95%CI 0.96-1.17，p=0.24）。
作者得出结论，对于大多数患有造釉细胞瘤的儿童和青少年，RT 起始时的 GTV 与 PD 风险无关。这一发现可能会影响手术实践，因为它表明，为提高 RT 疗效而进行积极的肿瘤减瘤术可能并非必要。然而，对于巨大肿瘤，可能需要新的策略来控制肿瘤。
