成人IDH突变型胶质瘤的质子治疗：Proglio-1，一项多中心回顾性研究。

Proton therapy for adult type IDH-mutated glioma: Proglio-1, a multicenter retrospective study.

作者信息

Goliot Nicolas, Jouglar Emmanuel, Jacob Julian, Christy François, Seutin Eva, Schiappa Renaud, Dumont Sarah, Mohssine Selim, Stefan Dinu, Leclerc Arthur, Emery Evelyne, Moignier Cyril, Riverain Jeanne, Missohou Fernand, Fontanilles Maxime, Valable Samuel, Balosso Jacques, Doyen Jérôme, Lesueur Paul

机构信息

Radiation Oncology Department, François Baclesse Comprehensive Cancer Center, Caen, 14000, France.

Université de Caen Normandie, CNRS, ISTCT UMR6030, GIP CYCERON, Caen, 14000, France.

出版信息

Radiat Oncol. 2025 Aug 5;20(1):124. doi: 10.1186/s13014-025-02702-y.

DOI:10.1186/s13014-025-02702-y

PMID:40764578

Abstract

BACKGROUND

Gliomas with isocitrate dehydrogenase (IDH) mutation affect young adults with a long-life expectancy. While radiotherapy is effective, studies have shown its detrimental effects on cognition and quality of life. Unlike photon radiotherapy, proton therapy better spares healthy tissue. This study aimed to report mid-term survival and toxicities of proton therapy in a multicentric cohort of adults with IDH-mutant gliomas.

METHODS

We retrospectively analyzed 90 patients treated with proton therapy in France since 2016, including 60 with IDH-mutated astrocytomas and 30 with oligodendrogliomas. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier and compared with the log-rank test. Prognostic factors were assessed using univariate Cox models. Toxicities, radiation-induced-contrast-enhancement (RICE) and patterns of recurrence were evaluated.

RESULTS

At the time of proton therapy, World Health Organization (WHO) pathology grades 2, 3, and 4 were observed in 42%, 54%, and 3% of patients, respectively. Protons were delivered as upfront therapy in 41 patients and after recurrence in 49. After a median follow-up of 27.3 months, median OS was not reached, and median PFS was 42.5 months for the whole cohort. WHO grades 3-4 had lower PFS than WHO grade 2 (p = 0.044). Patterns of recurrence were in-field (79%), out-of-field (7%), borderline (4%), and mixed (11%). Proton therapy was well tolerated, with only three grade > 2 toxicities. RICE occurred in 23 patients, but 74% of them did not require any treatment.

CONCLUSIONS

Proton therapy in IDH-mutated gliomas shows a favorable mid-term tolerance and efficacy profile.

摘要

背景

异柠檬酸脱氢酶（IDH）突变型胶质瘤影响预期寿命较长的年轻成年人。虽然放射治疗有效，但研究表明其对认知和生活质量有不利影响。与光子放射治疗不同，质子治疗能更好地保护健康组织。本研究旨在报告质子治疗在多中心队列的IDH突变型胶质瘤成年患者中的中期生存率和毒性。

方法

我们回顾性分析了自2016年以来在法国接受质子治疗的90例患者，包括60例IDH突变型星形细胞瘤患者和30例少突胶质细胞瘤患者。采用Kaplan-Meier法估计总生存期（OS）和无进展生存期（PFS），并通过对数秩检验进行比较。使用单变量Cox模型评估预后因素。评估毒性、放射诱导的对比增强（RICE）和复发模式。

结果

在进行质子治疗时，世界卫生组织（WHO）病理分级为2级、3级和4级的患者分别占42%、54%和3%。41例患者将质子治疗作为一线治疗，49例患者在复发后接受质子治疗。中位随访27.3个月后，整个队列未达到中位OS，中位PFS为42.5个月。WHO 3-4级患者的PFS低于WHO 2级患者（p = 0.04）。复发模式为野内（79%）、野外（7%）、边缘（4%）和混合（11%）。质子治疗耐受性良好，只有3例毒性>2级。23例患者出现RICE，但其中7４%不需要任何治疗。