A Multi-institutional Comparative Analysis of Proton and Photon Therapy-Induced Hematologic Toxicity in Patients With Medulloblastoma
A Multi-institutional Comparative Analysis of Proton and Photon Therapy-Induced Hematologic Toxicity in Patients With Medulloblastoma
复制标题
髓母细胞瘤患者质子和光子治疗所致血液学毒性的多机构比较分析
DOI：
10.1016/j.ijrobp.2020.09.049
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发表时间：
2021-01-28
影响因子：
7
通讯作者：
MacDonald, Shannon M.
中科院分区：
文献类型：
--
作者：
Liu, Kevin X.;Ioakeim-Ioannidou, Myrsini;MacDonald, Shannon M.
目的：本多机构回顾性研究旨在研究颅脊髓照射（CSI）在儿童髓母细胞瘤患者使用质子或光子therapy.Methods和材料的血液学效果：临床和治疗特征记录了97例儿童髓母细胞瘤谁收到CSI没有同步化疗或同步单药长春新碱从2000年至2017年。60名和37名患者分别接受了质子和光子治疗。采用Kaplan-Meier曲线和对数秩检验确定总生存期。使用Bonferroni校正的多重t检验比较每个时间点的血细胞计数。考克斯回归分析结果：接受质子和光子CSI的患者的中位年龄分别为7.5岁（范围，3.5-22.7岁）和9.9岁（范围，3.6-19.5岁）。大多数患者诊断为标准风险髓母细胞瘤，质子和光子队列分别为86.7%和89.2%。两个队列的受累野或整个后颅窝的中位总剂量为54.0戈伊/戈伊相对生物学有效性（RBE），中位CSI剂量为23.4戈伊/戈伊（RBE）（范围，18-36戈伊/戈伊[RBE]）。在放射治疗（RT）的第3 - 6周，质子队列的计数显著高于光子队列。虽然两个队列的白色血细胞计数没有差异，但接受质子RT的患者在整个RT过程中淋巴细胞计数显著较高。当排除接受椎体保留质子RT的患者或仅限于接受23.4戈伊的患者时，观察到相似的结果。在单变量和多变量分析中，只有光子治疗与血液学毒性>= 3级的时间缩短相关。未观察到总生存率差异，淋巴细胞减少症并不能预测生存率。结论：与接受光子治疗的患者相比，接受质子治疗的CSI患者的血液毒性显着降低。爱思唯尔公司出版
Purpose: This multi-institutional retrospective study sought to examine the hematologic effects of craniospinal irradiation (CSI) in pediatric patients with medulloblastoma using proton or photon therapy.Methods and Materials: Clinical and treatment characteristics were recorded for 97 pediatric patients with medulloblastoma who received CSI without concurrent chemotherapy or with concurrent single-agent vincristine from 2000 to 2017. Groups of 60 and 37 patients underwent treatment with proton-based and photon-based therapy, respectively. Overall survival was determined by Kaplan-Meier curves with log-rank test. Comparisons of blood counts at each timepoint were conducted using multiple t tests with Bonferroni corrections. Univariate and multivariate analyses of time to grade >= 3 hematologic toxicity were performed with Cox regression analyses.Results: Median age of patients receiving proton and photon CSI was 7.5 years (range, 3.5-22.7 years) and 9.9 years (range, 3.6-19.5 years), respectively. Most patients had a diagnosis of standard risk medulloblastoma, with 86.7% and 89.2% for the proton and photon cohorts, respectively. Median total dose to involved field or whole posterior fossa was 54.0 Gy/Gy relative biological effectiveness (RBE) and median CSI dose was 23.4 Gy/Gy(RBE) (range, 18-36 Gy/Gy[RBE]) for both cohorts. Counts were significantly higher in the proton cohort compared with the photon cohort in weeks 3 to 6 of radiation therapy (RT). Although white blood cell counts did not differ between the 2 cohorts, patients receiving proton RT had significantly higher lymphocyte counts throughout the RT course. Similar results were observed when excluding patients who received vertebral body sparing proton RT or limiting to those receiving 23.4 Gy. Only photon therapy was associated with decreased time to grade >= 3 hematologic toxicity on univariate and multivariable analyses. No difference in overall survival was observed, and lymphopenia did not predict survival.Conclusions: Patients who receive CSI using proton therapy experience significantly decreased hematologic toxicity compared with those receiving photon therapy. Published by Elsevier Inc.