Hypo-Fractionated versus Standard Fractionation Radiotherapy in Frail and Elderly Patients with Central Nervous System Solitary Fibrous Tumors.

IF 1.8 3区医学 Q3 ONCOLOGY Oncology Pub Date : 2025-01-01 Epub Date: 2025-02-25 DOI:10.1159/000543847

Ory Haisraely, Ory Haisraely, Marcia Jaffe, Alisa Taliansky, Zvi R Cohen, Yaakov R Lawerence

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Abstract

Introduction: Central nervous system solitary fibrous tumors (cSFTs) are rare, accounting for less than 1% of central nervous system tumors. Treatment guidelines are limited, especially for frail or elderly patients. Gross total resection followed by radiotherapy is recommended for higher grade cases, but the role of hypofractionated (HF) radiotherapy versus standard fractionation (SF) in this population remains unclear. This study evaluates outcomes of HF compared to SF in frail patients with cSFT.

Methods: A retrospective analysis of 51 frail patients (age >65, Karnofsky performance status [KPS] <80) with cSFT treated from 2015 to 2023 was performed. Patients received either HF (21 patients) or SF (30 patients). Data extracted included demographics, tumor characteristics, surgical outcomes, radiation regimens, and oncologic outcomes. Descriptive and survival analyses were conducted using the Kaplan-Meier methods, with multivariable analysis via Cox regression models to assess factors influencing local control and overall survival.

Results: The median follow-up was 19 months (11-55 months). HF regimens varied from 35-48 Gy in 10-15 fractions, while SF was predominantly 54-60 Gy in 28-30 fractions. Local control was achieved in 76.2% of HF and 80% of SF patients (p = 0.154). No statistical difference in overall survival was observed between HF (18 months) and SF (18 months, p = 0.54). Higher tumor grade (HR = 3.5, p = 0.021) and incomplete resection (HR = 0.72, p = 0.035) negatively impacted local control. KPS ≤50 was associated with reduced survival (HR = 2.3, p = 0.035).

Conclusions: HF radiotherapy appears feasible and safe for frail patients with cSFT, providing comparable outcomes to SF. The reduced treatment burden of HF may benefit patients with limited performance status. Further research is needed to guide optimal treatment approaches for this unique population. HF vs. SF radiotherapy in frail and elderly patients with cSFTs.

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低分位与标准分位放疗在体弱及老年中枢神经系统孤立性纤维性肿瘤患者中的应用。

中枢神经系统孤立性纤维性肿瘤（cSFTs）较为罕见，占中枢神经系统肿瘤的不到1%。治疗指南是有限的，特别是对体弱或老年患者。对于恶性程度较高的病例，建议采用大体全切除后放疗，但在这一人群中，低分割放疗（HF）与标准分割放疗（SF）的作用尚不清楚。本研究评估了体弱cSFT患者的HF与SF的预后。方法：回顾性分析51例体弱患者（年龄bb ~ 65岁，KPS）。结果：中位随访时间为19个月（11 ~ 55个月）。HF方案在10-15个馏分中变化为35-48 Gy，而SF方案在28-30个馏分中主要为54-60 Gy。76.2%的HF患者和80%的SF患者获得局部控制（p=0.154）。HF（18个月）与SF（18个月，p=0.54）的总生存期无统计学差异。较高的肿瘤分级（HR=3.5, p=0.021）和不完全切除（HR=0.72, p=0.035）对局部控制有负面影响。KPS≤50与生存率降低相关（HR=2.3, p=0.035）。结论：对于虚弱的cSFT患者，低分割放疗似乎是可行和安全的，提供了与标准分割相当的结果。心衰治疗负担的减轻可能会使体能状况有限的患者受益。需要进一步的研究来指导针对这一独特人群的最佳治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.