Reirradiation for Rectal Cancer Using Pencil Beam Scanning Proton Therapy: A Single Institutional Experience.
Reirradiation for Rectal Cancer Using Pencil Beam Scanning Proton Therapy: A Single Institutional Experience.
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DOI：
10.1016/j.adro.2020.10.008
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发表时间：
2021-01
影响因子：
2.3
通讯作者：
Regine WF
中科院分区：
文献类型：
--
作者：
Koroulakis A;Molitoris J;Kaiser A;Hanna N;Bafford A;Jiang Y;Bentzen S;Regine WF
盆腔放射治疗(RT)后的直肠癌再照射(RC)已被证明是安全有效的。然而，关于质子治疗(PT)的数据有限，包括铅笔束扫描质子治疗(PBS-PT)。我们假设PT对于再次治疗是安全和可行的，并且可以减少毒性和治疗升级。对所有接受PBS-PT再次照射的RC和既往盆腔RT的患者进行了一项单一机构、回顾、机构审查委员会批准的分析。收集了有关患者和治疗特点及结果的数据。使用Kaplan-Meier方法评估局部进展、无进展生存期、总生存期和晚期毒性。2016~2019年间，28例患者(中位随访期28.6个月)接受了PBS-PT再照射，其中18例复发RC患者(中位数既往剂量：54.0GY)和10例初发RC和可变既往RT患者。中位再照射剂量为44.4Gy16.0~60.0Gy28例中21例每日2次，其中24例同时接受化疗。6例行手术切除。3例(10.7%)出现3级急性毒性反应，1例因毒性未完成放疗。4例(14.2%)出现晚期3级毒性，包括1例既往有放射治疗相关损伤的患者出现1例5级毒性。1年局部进展、无进展生存率和总生存率分别为33.7%(95%可信区间，14.5%~52.9%)、45.0%(95%可信区间，26.2%~63.8%)和81.8%(95%可信区间，67.3%~96.3%)。这是使用PT对RC进行再照射的最大系列，也是第一次使用PBS-PT进行研究。低急性毒副作用和可接受的晚期毒性支持PBS-PT作为这一高危患者群体的一种选择，并需要继续随访。
Reirradiation for rectal cancer (RC) after prior pelvic radiation therapy (RT) has been shown to be safe and effective. However, limited data exist for proton therapy (PT), including pencil beam scanning proton therapy (PBS-PT). We hypothesize that PT is safe and feasible for re-treatment and may allow for decreased toxicity and treatment escalation. A single-institution, retrospective, institutional review board–approved analysis of all patients with RC and prior pelvic RT receiving PBS-PT reirradiation was performed. Data on patient and treatment characteristics and outcomes were collected. Local progression, progression-free survival, overall survival, and late grade >3 toxicity were estimated using the Kaplan-Meier method. Twenty-eight patients (median follow-up: 28.6 months) received PBS-PT reirradiation between 2016 and 2019, including 18 patients with recurrent RC (median prior dose: 54.0 Gy) and 10 patients with de novo RC and variable prior RT. The median reirradiation dose was 44.4 Gy (range, 16.0-60.0 Gy; 21 of 28 twice daily), and 24 of 28 patients received concurrent chemotherapy. Six underwent surgical resection. Three (10.7%) experienced grade 3 acute toxicities, and 1 did not complete RT owing to toxicity. Four (14.2%) had late grade <3 toxicity, including 1 grade 5 toxicity in a patient with a prior RT-related injury. The 1-year local progression, progression-free survival, and overall survival rates were 33.7% (95% confidence interval [CI], 14.5%-52.9%), 45.0% (95% CI, 26.2%-63.8%), and 81.8% (95% CI, 67.3%-96.3%), respectively. This is the largest series using PT for reirradiation for RC and the first study using PBS-PT. Low acute toxicity rates and acceptable late toxicity support PBS-PT as an option for this high-risk patient population, with a need for continued follow-up.
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影响因子：
5.7
作者：
Tao, Randa;Tsai, Chiaojung Jillian;Das, Prajnan
通讯作者：
Das, Prajnan
DOI：
10.1016/s0360-3016(97)00340-4
发表时间：
1997-10-01
影响因子：
7
作者：
Mohiuddin, M;Marks, GM;Marks, J
通讯作者：
Marks, J
DOI：
10.1016/0360-3016(93)90538-7
发表时间：
1993-12-01
影响因子：
7
作者：
MOHIUDDIN, M;LINGAREDDY, V;MARKS, G
通讯作者：
MARKS, G
影响因子：
158.5
作者：
Sauer, R;Becker, H;Raab, R
通讯作者：
Raab, R
影响因子：
45.3
作者：
Sauer, Rolf;Liersch, Torsten;Roedel, Claus
通讯作者：
Roedel, Claus