Mizumoto Masashi, Fukushima Hiroko, Oshiro Yoshiko, Saito Takashi, Muroi Ai, Yamaki Yuni, Hosaka Sho, Inaba Masako, Ishiguro Toshitaka, Harada Masahiko, Niitsu Hikaru, Ishida Toshiki, Sumiya Taisuke, Baba Keiichiro, Nakamura Masatoshi, Numajiri Haruko, Nakai Kei, Sakurai Hideyuki
Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan.
Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan.
Front Oncol. 2025 Sep 12;15:1644839. doi: 10.3389/fonc.2025.1644839. eCollection 2025.
Proton beam therapy (PBT) is increasingly used for pediatric intracranial tumors due to lower long-term radiation-associated toxicities. However, data on late adverse effects, particularly brain necrosis and intracranial secondary cancer, remain limited. The aim of this study is to evaluate the incidence of these events following PBT in pediatric patients treated at a single center.
We retrospectively reviewed the medical records of 189 patients under 20 years of age who received PBT for intracranial tumors between 1991 and 2023. Clinical information, irradiation parameters, concurrent chemotherapy, and follow-up outcomes were collected. Brain necrosis and intracranial secondary cancers were assessed based on events presenting with grade ≥2 clinical symptoms.
Among 151 patients with sufficient follow-up data (median follow-up: 41.7 months), two cases of brain necrosis (1.3%) and two cases of intracranial secondary cancer (1.3%) were identified. The 5-year cumulative incidence was 2.3% (95% CI: 0-5.4%) for brain necrosis and 2.7% (95% CI: 0-6.4%) for intracranial secondary cancer. These respective incidence rates were similar for patients followed for more than two years (n=94), and slightly higher at 2.7% and 3.1% for those receiving a total dose >50 Gy (n=134). Among patients treated with PBT alone (n=125), the incidence was 1.7% for brain necrosis and 3.6% for secondary malignancy.
This single-center retrospective study shows a low incidence of brain necrosis and secondary malignancy following PBT for pediatric patients with intracranial tumors. These findings indicate a favorable long-term safety profile of PBT in this population.
由于长期辐射相关毒性较低，质子束治疗（PBT）在儿科颅内肿瘤治疗中的应用越来越广泛。然而，关于晚期不良反应的数据，尤其是脑坏死和颅内继发癌，仍然有限。本研究的目的是评估在单一中心接受PBT治疗的儿科患者中这些事件的发生率。
我们回顾性分析了1991年至2023年间189例20岁以下因颅内肿瘤接受PBT治疗患者的病历。收集了临床信息、照射参数、同步化疗及随访结果。根据出现≥2级临床症状的事件评估脑坏死和颅内继发癌。
在151例有充分随访数据的患者中（中位随访时间：41.7个月），发现2例脑坏死（1.3%）和2例颅内继发癌（1.3%）。脑坏死的5年累积发生率为2.3%（95%CI：0 - 5.4%），颅内继发癌为2.7%（95%CI：0 - 6.4%）。随访超过两年的患者（n = 94）的这些发生率相似，而接受总剂量>50 Gy的患者（n = 134）的发生率略高，分别为2.7%和3.1%。在仅接受PBT治疗的患者中（n = 125），脑坏死发生率为1.7%，继发恶性肿瘤发生率为3.6%。
这项单中心回顾性研究表明，儿科颅内肿瘤患者接受PBT后脑坏死和继发恶性肿瘤的发生率较低。这些发现表明PBT在该人群中具有良好的长期安全性。
