Analysis of pseudoprogression after proton or photon therapy of 99 patients with low grade and anaplastic glioma
Analysis of pseudoprogression after proton or photon therapy of 99 patients with low grade and anaplastic glioma
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DOI：
10.1016/j.ctro.2018.01.002
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发表时间：
2018-02-01
影响因子：
3.1
通讯作者：
McGovern, Susan L.
中科院分区：
文献类型：
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作者：
Bronk, Julianna K.;Guha-Thakurta, Nandita;McGovern, Susan L.
背景和目的：质子疗法越来越多地用于治疗原发性脑肿瘤。人们担心，与光子相比，质子之后的赝进展（PsP）率更高。本研究的目的是比较质子与光子治疗 II 级和 III 级胶质瘤后 PsP 的发生率，并确定与 PsP 发生相关的因素。 材料和方法：对 99 名年龄 > 18 岁的 II 级或 III 级胶质瘤接受光子或质子治疗的患者进行回顾性分析。分析了人口统计数据、IDH 和 1p19q 状态以及治疗因素与 PsP、无进展生存期 (PFS) 和总生存期 (OS) 的关系。结果：65 名患者接受了光子治疗，34 名患者接受了质子治疗。在少突胶质细胞瘤患者中，6/42 接受光子治疗的患者（14.3%）和 4/25 接受质子治疗的患者（16%，p = 1.00）出现 PsP。在星形细胞瘤患者中，3/23 接受光子治疗的患者 (13%) 和 1/9 接受质子治疗的患者 (11.1%，p = 1.00) 出现 PsP。根据放射类型、放射剂量、肿瘤分级、1p19q 联合缺失或 IDH 状态，PsP 率没有差异。与光子治疗相比，少突胶质细胞瘤患者的 PsP 发生时间更早，分别为 48 天与 131 天，p < .01。在多变量分析中，总切除（p = .03，HR = 0.48，95% CI = 0.25-0.93）和 PsP（p = .04，HR = 0.22，95% CI = 0.05-0.91）与更好的 PFS 相关； IDH 突变与更好的 OS 相关（p < .01，HR = 0.22，95% CI = 0.08-0.65）。结论：与光子相比，少突胶质细胞瘤患者在质子治疗后较早出现 PsP，但星形细胞瘤患者则不然。 PsP 与更好的 PFS 相关。 (C) 2018 作者。由 Elsevier B.V. 代表欧洲放射治疗和肿瘤学会出版。
Background and purpose: Proton therapy is increasingly used to treat primary brain tumors. There is concern for higher rates of pseudoprogression (PsP) after protons compared to photons. The purposes of this study are to compare the rate of PsP after proton vs. photon therapy for grade II and III gliomas and to identify factors associated with the development of PsP.Materials and methods: Ninety-nine patients age >18 years with grade II or III glioma treated with photons or protons were retrospectively reviewed. Demographic data, IDH and 1p19q status, and treatment factors were analyzed for association with PsP, progression free survival (PFS), and overall survival (OS).Results: Sixty-five patients were treated with photons and 34 with protons. Among those with oligodendroglioma, PsP developed in 6/42 photon-treated patients (14.3%) and 4/25 proton-treated patients (16%, p = 1.00). Among those with astrocytoma, PsP developed in 3/23 photon-treated patients (13%) and 1/9 proton-treated patients (11.1%, p = 1.00). There was no difference in PsP rate based on radiation type, radiation dose, tumor grade, 1p19q codeletion, or IDH status. PsP occurred earlier in oligodendroglioma patients treated with protons compared to photons, 48 days vs. 131 days, p < .01. On multivariate analyses, gross total resection (p = .03, HR = 0.48, 95%CI = 0.25-0.93) and PsP (p = .04, HR = 0.22, 95% CI = 0.05-0.91) were associated with better PFS; IDH mutation was associated with better OS (p < .01, HR = 0.22, 95%CI = 0.08-0.65).Conclusions: Patients with oligodendroglioma but not astrocytoma develop PsP earlier after protons compared to photons. PsP was associated with better PFS. (C) 2018 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.