Evolution of Proton Radiation Therapy Brainstem Constraints on the Pediatric Proton/Photon Consortium Registry

IF 3.4 3区 医学 Q2 ONCOLOGY Practical Radiation Oncology Pub Date : 2024-11-01 DOI:10.1016/j.prro.2024.05.013
Dora Correia MD , Daniel J. Indelicato MD , Arnold C. Paulino MD , Ralph Ermoian MD , Stephen Mihalcik MD , Stephanie M. Perkins MD , Christine Hill-Kayser MD , Victor S. Mangona MD , Jae Lee MD , John Han-Chih Chang MD , Nadia N. Laack MD, MS , Young Kwok MD , John Perentesis MD , Ralph Vatner MD , Ronak Dave MD , Sara L. Gallotto MS , Miranda P. Lawell MS , Benjamin V.M. Bajaj MA , Keith W. Allison MS , Alisa Perry BSN , Torunn I. Yock MD, MCH
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Abstract

Purpose

Increasing concern that brainstem toxicity incidence after proton radiation therapy might be higher than with photons led to a 2014 University of Florida (UF) landmark paper identifying its risk factors and proposing more conservative dose constraints. We evaluated how practice patterns changed among the Pediatric Proton/Photon Consortium Registry (PPCR).

Material and Methods

This prospective multicenter cohort study gathered data from patients under the age of 22 years enrolled on the PPCR, treated between 2002 and 2019 for primary posterior fossa brain tumors. After standardizing brainstem contours, we garnered dosimetry data and correlated those meeting the 2014 proton-specific brainstem constraint guidelines by treatment era, histology, and extent of surgical resection.

Results

A total of 467 patients with evaluable proton radiation therapy plans were reviewed. Median age was 7.1 years (range: <1-21.9), 63.0% (n = 296) were men, 76.0% (n = 357) were White, and predominant histology was medulloblastoma (55.0%, n = 256), followed by ependymoma (27.0%, n = 125). Extent of resection was mainly gross total resection (GTR) (67.0%, n = 312), followed by subtotal resection (STR) or biopsy (20.0%, n = 92), and near total resection (NTR) (9.2%, n = 43). The UF brainstem constraint metrics most often exceeded were the goal D50% of 52.4 gray relative biological equivalents (43.3%, n = 202) and maximal D50% of 54 gray relative biological equivalents (12.6%, n = 59). The compliance rate increased after the new guidelines (2002-2014: 64.0% vs 2015-2019: 74.6%, P = .02), except for ependymoma (46.3% pre- vs 50.0% post-guidelines, P = .86), presenting lower compliance (48.8%) in comparison to medulloblastoma/ primitive neuroectodermal tumors/pineoblastoma (77.7%), glioma (89.1%), and atypical teratoid/rhabdoid tumors (90.9%) (P < .001). Degree of surgical resection did not affect compliance rates (GTR/NTR 71.0% vs STR/biopsy 72.8%, P = .45), even within the ependymoma subset (GTR/NTR 50.5% vs STR/biopsy 38.1%, P = .82).

Conclusion

Since the publication of the UF guidelines, the pediatric proton community has implemented more conservative brainstem constraints in all patients except those with ependymoma, irrespective of residual disease after surgery. Future work will evaluate if this change in practice is associated with decreased rates of brainstem toxicity.
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儿科质子/光子联盟登记处质子放疗脑干制约因素的演变。
导言:质子放疗(PRT)后脑干毒性发生率可能高于光子放疗,这一问题日益受到关注,因此,2014 年 XXXX(XX)发表了一篇具有里程碑意义的论文,确定了脑干毒性的风险因素,并提出了更为保守的剂量限制。我们评估了 XXXX(XXXX)的实践模式是如何变化的:这项前瞻性多中心队列研究收集了 2002-2019 年间在 XXXX 接受治疗的 22 岁以下原发性后窝脑肿瘤患者的数据。在对脑干轮廓进行标准化后,我们收集了剂量测定数据,并按照治疗年代、组织学和手术切除范围对符合2014年质子特异性脑干限制指南的患者进行了关联:共审查了467例可评估PRT计划的患者。中位年龄为 7.1 岁(范围:52.4 GyRBE 的 50%):50%为52.4 GyRBE(43.3%,n=202),最大D50%为54 GyRBE(12.6%,n=59)。新指南发布后,符合率有所提高(2002-2014 年:64.0% vs. 2015-2019 年:74.6%,p=0.02),但上皮瘤除外(指南发布前 46.3% vs. 发布后 50.0%,p=0.86),其符合率(48.8%)低于髓母细胞瘤/PNET/松母细胞瘤(77.7%)、胶质瘤(89.1%)和 ATRT(90.9%)(p结论:自 XX 指南发布以来,儿科质子治疗界对除上皮瘤以外的所有患者都实施了更为保守的脑干限制,无论术后是否有残留疾病。未来的工作将评估这种做法的改变是否与脑干毒性发生率的降低有关。
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来源期刊
Practical Radiation Oncology
Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
5.20
自引率
6.10%
发文量
177
审稿时长
34 days
期刊介绍: The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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