Proton versus photon craniospinal irradiation for adult medulloblastoma: a dosimetric, toxicity, and exploratory cost analysis

W. Breen, Connie S Geno, M. Waddle, Jing Qian, W. S. Harmsen, Terence C Burns, U. Sener, M. Ruff, B. J. Neth, J. Uhm, D. Routman, Elizabeth S Yan, Jon J. Kruse, Nadia N. Laack, P. D. Brown, Anita Mahajan
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Abstract

This study aimed to determine whether proton craniospinal irradiation (CSI) decreased dose to normal tissue and resulted in less toxicity than photon CSI for adult patients. This single institution retrospective analyzed differences in radiation doses, acute toxicity, and cost between proton and CSI for adult medulloblastoma patients. Of 39 total patients, 20 were treated with photon CSI prior to 2015, and 19 were treated with proton CSI thereafter. Median age was 28 years (range 18-66). Molecular subtype was most commonly sonic hedgehog (68%). Patients most commonly received 36 Gy CSI in 20 fractions with a boost to 54-55.8 Gy (92%). Proton CSI delivered significantly lower mean doses to cochleae, lacrimal glands, lens, parotid glands, pharyngeal constrictors, esophagus, lungs, liver, and skin (all p< 0.001). Patients receiving proton CSI had significantly lower rates of acute dysphagia of any grade (5% vs. 35%, p= 0.044) and decreased median weight loss during radiation (+1.0 vs. -2.8 kg, p= 0.011). Weight loss was associated with acute hospitalization (p= 0.009). Median follow-up was 2.9 and 12.9 years for proton and photon patients, respectively, limiting late toxicity and outcome comparisons. At last follow-up, five photon patients had died (two of progressive disease, three without recurrence ages 41-63) and 21% had experienced major cardiovascular events. At 10 years, 89% were alive and 82% were recurrence free. This study demonstrates dosimetric improvements with proton CSI, potentially leading to decreased acute toxicity including dysphagia and weight loss during treatment.
成人髓母细胞瘤的质子与光子颅椎照射:剂量、毒性和探索性成本分析
本研究旨在确定质子颅椎体照射(CSI)是否比光子颅椎体照射(CSI)对成年患者减少了正常组织的剂量并降低了毒性。 这项单一机构的回顾性研究分析了质子和CSI对成年髓母细胞瘤患者在辐射剂量、急性毒性和费用方面的差异。 在总共39名患者中,20名患者在2015年之前接受了光子CSI治疗,19名患者在2015年之后接受了质子CSI治疗。中位年龄为28岁(18-66岁不等)。分子亚型最常见的是声刺猬(68%)。患者最常接受的是 36 Gy CSI,分 20 次进行,每次提升至 54-55.8 Gy(92%)。质子 CSI 对耳蜗、泪腺、晶状体、腮腺、咽部收缩器、食道、肺、肝脏和皮肤的平均剂量明显较低(均 p< 0.001)。接受质子CSI治疗的患者发生任何程度急性吞咽困难的比例明显较低(5%对35%,P= 0.044),放射治疗期间体重减轻的中位数也有所减少(+1.0对-2.8千克,P= 0.011)。体重减轻与急性住院有关(p= 0.009)。质子和光子患者的中位随访时间分别为 2.9 年和 12.9 年,这限制了后期毒性和结果的比较。在最后一次随访中,5 名光子患者死亡(2 人死于疾病进展,3 人无复发,年龄在 41-63 岁之间),21% 的患者经历了重大心血管事件。10年后,89%的患者存活,82%的患者无复发。 这项研究表明,质子 CSI 在剂量学方面有所改进,可能会减少急性毒性,包括治疗期间的吞咽困难和体重减轻。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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