Clinical Outcomes of Carbon Ion Radiation Therapy for Malignant Peripheral Nerve Sheath Tumors

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2024-09-03 DOI:10.1016/j.adro.2024.101619

Maria Rosaria Fiore MD , Agnieszka Chalaszczyk MD , Amelia Barcellini MD , Viviana Vitolo MD , Giulia Fontana MSc , Stefania Russo MSc , Marco Rotondi MD , Silvia Molinelli MSc , Alfredo Mirandola MSc , Alessia Bazani MSc , Ester Orlandi MD

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Abstract

Purpose

To investigate the outcome and toxicity of patients affected by malignant peripheral nerve sheath tumors (MPNSTs) treated with high-dose carbon ion radiation therapy (CIRT).

Methods and Materials

We retrospectively analyzed the outcome of 23 patients with MPNSTs treated between July 2013 and December 2020. Out of these, 13 patients (56.5%) had incompletely resected tumors, 8 patients (34.7%) experienced recurrence after surgery, and 2 patients (8.7%) had unresectable tumors. Before CIRT treatment, 4 patients underwent a second surgery after the first local recurrence (LR), and 1 patient underwent a third surgery for the second local relapse of the disease. Six (26%) patients received neoadjuvant chemotherapy. The most frequent tumor site was the brachial plexus (n = 9; 39.1%). In 5 patients (21.7%), neurofibromatosis type 1 disorder was found, while 4 patients (17, 4%) had radiation-induced MPNSTs. The median CIRT prescribed total dose was 69.8 Gy (relative biological effectiveness; range, 54-76.8) delivered in a median of 16 fractions (range, 15-22). Eleven patients (47.82%) were treated according to a sequential boost protocol with a median prescribed dose to clinical target volume LR of 45 Gy (relative biological effectiveness; range, 41.4-54).

Results

After a median follow-up time of 23 months (range, 3-100 months), the overall survival rates at 1 and 2 years were 82.38% and 61.51%, respectively. The 1-year and 2-year local relapse-free survival rates were 65.07% and 48.80%, respectively, and the 1-year and 2-year progression-free survival rates were 56.37% and 40.99%, respectively. No patients showed acute or late grade 4 toxicity or any treatment-related deaths. Ten patients (43.48%) reported acute toxicities of grade ≥ 2, which included dermatitis in 6 patients, mucositis in 2 patients, and peripheral neuropathy in 4 patients. Eight patients (34.78%) reported late toxicities of grade ≥ 2, mainly due to loco-regional neuropathy.

Conclusions

High-dose CIRT shows favorable local effects with acceptable toxicities in patients with gross residual and LR after surgery or unresectable malignant peripheral nerve sheath tumors. Advanced treatment modalities such as particle therapy should be considered for MPNSTs.

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碳离子放射治疗恶性周围神经鞘瘤的临床效果

目的探讨采用高剂量碳离子放射治疗（CIRT）治疗恶性周围神经鞘瘤（MPNST）患者的疗效和毒性。方法和材料我们回顾性分析了2013年7月至2020年12月期间接受治疗的23例MPNST患者的疗效。其中，13 名患者（56.5%）肿瘤未完全切除，8 名患者（34.7%）术后复发，2 名患者（8.7%）肿瘤无法切除。CIRT 治疗前，4 名患者在首次局部复发（LR）后接受了第二次手术，1 名患者因第二次局部复发接受了第三次手术。6名患者（26%）接受了新辅助化疗。最常见的肿瘤部位是臂丛（9；39.1%）。5名患者（21.7%）患有神经纤维瘤病1型，4名患者（17.4%）患有辐射诱发的多发性骨髓瘤。CIRT处方总剂量的中位数为69.8 Gy（相对生物有效性；范围为54-76.8），中位数为16分次（范围为15-22）。有 11 名患者（47.82%）接受了序贯增强方案治疗，临床靶体积 LR 的中位处方剂量为 45 Gy（相对生物有效性；范围：41.4-54）。结果经过 23 个月（范围：3-100 个月）的中位随访，1 年和 2 年的总生存率分别为 82.38% 和 61.51%。1年和2年无局部复发生存率分别为65.07%和48.80%，1年和2年无进展生存率分别为56.37%和40.99%。没有患者出现急性或晚期4级毒性或任何与治疗相关的死亡。10名患者（43.48%）报告急性毒性≥2级，包括6名患者的皮炎、2名患者的粘膜炎和4名患者的周围神经病变。结论高剂量 CIRT 对术后大体残留和 LR 或无法切除的恶性周围神经鞘瘤患者具有良好的局部疗效和可接受的毒性。对于恶性周围神经鞘瘤，应考虑粒子治疗等先进的治疗方法。

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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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.