Proton therapy for pediatric and adolescent esthesioneuroblastoma
Proton therapy for pediatric and adolescent esthesioneuroblastoma
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DOI：
10.1002/pbc.25494
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发表时间：
2015-09-01
影响因子：
3.2
通讯作者：
Yock, Torunn I.
中科院分区：
文献类型：
--
作者：
Lucas, John T., Jr.;Ladra, Matthew M.;Yock, Torunn I.
背景鼻腔鼻窦的嗅神经母细胞瘤（EN）在儿童和青少年患者中占不到3%[1]。集体成人文献表明，放射治疗在实现治愈方面发挥着关键作用[2]，但儿科结局数据有限。由于靠近关键结构，接受EN的儿科患者的辐射可能导致显著的发病率。质子放射治疗提供了一个潜在的剂量学的好处，可能会改善长期生存和毒性结果在儿科人群[3]。MethodsWe回顾性地确定了8例患者的EN与质子放射治疗从2000-2013。使用Kaplan-Meier方法总结至发生临床终点事件的时间，从放疗完成之日开始。根据CTCAE v.4.0对毒性进行审查和分级。结果存活者的中位随访时间为4.6年（范围0.8-9.4年）。4年生存率为87.5%。8例患者中有4例（1例选择性）接受了全面颈部放疗。未观察到局部或区域失效。两名患者分别在0.6和1.3个月时因弥漫性软脑膜疾病和脑实质内转移而远端失败。四名患者放射相关的晚期毒性，包括内分泌功能障碍，2例2级视网膜病变和3级视神经neuropathy.ConclusionsIn一个有限的队列，质子放疗似乎提供了良好的局部疾病控制，即使在那些患者局部晚期疾病和颅内扩展。在我们的队列中，远期失败决定了总生存率。考虑到疾病部位和程度，毒性是可接受的。儿科血液癌症2015;62：1523-1528。(c)2015 Wiley Periodicals，Inc.
BackgroundEsthesioneuroblastoma (EN) of the paranasal sinus comprises less than 3% of tumors of in pediatric and adolescent patients [1]. The collective adult literature indicates a critical role for radiotherapy in attaining cure [2], yet pediatric outcome data is limited. Radiation in pediatric patients with EN can cause significant morbidity due to the proximity of critical structures. Proton radiotherapy offers a potential dosimetric benefit that may improve long-term survival and toxicity outcomes in the pediatric population [3].MethodsWe retrospectively identified eight patients treated for EN with proton radiotherapy from 2000-2013. Times to event clinical endpoints are summarized using the Kaplan-Meier methods and are from the date of radiotherapy completion. Toxicities are reviewed and graded according to CTCAE v. 4.0.ResultsMedian follow up was 4.6 years for survivors (range 0.8-9.4 years). The 4 year overall survival was 87.5%. Four of eight patients (one elective) had comprehensive neck radiotherapy. No local or regional failures were observed. Two patients failed distantly with diffuse leptomeningeal disease and intraparenchymal brain metastases, at 0.6 and 1.3 months respectively. Four patients developed radiation related late toxicities including endocrine dysfunction, two cases of grade 2 retinopathy and one case of grade 3 optic neuropathy.ConclusionsIn a limited cohort, proton radiotherapy appears to provide excellent locoregional disease control even in those patients with locally advanced disease and intracranial extension. Distant failure determined overall survival in our cohort. Toxicities were acceptable given disease location and extent. Pediatr Blood Cancer 2015;62:1523-1528. (c) 2015 Wiley Periodicals, Inc.