Clinical experience of craniospinal intensity-modulated spot-scanning proton therapy using large fields for central nervous system medulloblastomas and germ cell tumors in children, adolescents, and young adults
Clinical experience of craniospinal intensity-modulated spot-scanning proton therapy using large fields for central nervous system medulloblastomas and germ cell tumors in children, adolescents, and young adults
复制标题
DOI：
10.1093/jrr/rrz022
复制
发表时间：
2019-07-01
影响因子：
2
通讯作者：
Shirato, Hiroki
中科院分区：
文献类型：
--
作者：
Hashimoto, Takayuki;Shimizu, Shinichi;Shirato, Hiroki
强度调制质子颅脊髓照射（ipCSI）的结果尚不清楚。我们评估了我们新开发的ipCSI系统的临床受益，该系统集成了两个机架安装的正交在线X射线成像仪和一个机器人六自由度患者检查床。9名患者（7-19岁）接受ipCSI治疗。CSI的处方剂量范围为23.4 - 36.0戈伊（相对生物学有效性），分13-20次。4例青少年和年轻成人（AYA）患者（15岁或以上）接受了保留椎体ipCSI（VBSipCSI）治疗。将VBSipCSI后的骨髓抑制与先前在同一机构接受光子CSI治疗的8名AYA患者进行比较。9例患者的平均同质性指数（HI）为0.056（95%置信区间：0.044-0.068）。所有射束输送从开始到结束的平均时间为37 min 39 s +/- 2 min 24 s（最小到最大：22 min 49 s - 42 min 51 s）。在CSI结束后4周内，VBSipCSI组的最低白色血细胞、血红蛋白和血小板水平显著高于光子CSI组（分别为P = 0.0071、0.0453、0.0024）。在CSI结束后4周，VBSipCSI组显著高于光子CSI组（P = 0.0023，0.0414，0.0061）。图像引导ipCSI可在合理的时间内交付，并具有足够的HI。使用VBSipCSI，AYA患者的严重急性血液学毒性发生率低于使用光子CSI治疗的AYA患者。
The outcomes of intensity-modulated proton craniospinal irradiation (ipCSI) are unclear. We evaluated the clinical benefit of our newly developed ipCSI system that incorporates two gantry-mounted orthogonal online X-ray imagers with a robotic six-degrees-of-freedom patient table. Nine patients (7-19 years old) were treated with ipCSI. The prescribed dose for CSI ranged from 23.4 to 36.0 Gy (relative biological effectiveness) in 13-20 fractions. Four adolescent and young adult (AYA) patients (15 years or older) were treated with vertebral-bodysparing ipCSI (VBSipCSI). Myelosuppression following VBSipCSI was compared with that of eight AYA patients treated with photon CSI at the same institution previously. The mean homogeneity index (HI) in the nine patients was 0.056 (95% confidence interval: 0.044-0.068). The mean time from the start to the end of all beam delivery was 37 min 39 s +/- 2 min 24 s (minimum to maximum: 22 min 49 s - 42 min 51 s). The nadir white blood cell, hemoglobin, and platelet levels during the 4 weeks following the end of the CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0071, 0.0453, 0.0024, respectively). The levels at 4 weeks after the end of CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0023, 0.0414, 0.0061). Image-guided ipCSI was deliverable in a reasonable time with sufficient HI. Using VBSipCSI, AYA patients experienced a lower incidence of serious acute hematological toxicity than AYA patients treated with photon CSI.