使用单拱顶同步回旋加速器系统质子治疗儿科患者脑干毒性。

IF 2.1 Q3 ONCOLOGY International Journal of Particle Therapy Pub Date : 2022-06-03 eCollection Date: 2022-01-01 DOI:10.14338/IJPT-22-00008.1
Inema Orukari, Stephanie Perkins, Tianyu Zhao, Jiayi Huang, Douglas F Caruthers, Sai Duriseti
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引用次数: 2

摘要

目的:颅放射治疗仍然是根治性治疗儿科脑肿瘤患者的一个组成部分。质子束放射治疗(PBT)可以限制对周围正常组织的附带辐射剂量,从而减少脱靶照射,同时保持适当的肿瘤覆盖。虽然PBT治疗颅内恶性肿瘤的儿科患者比光子治疗有明显的优势,但PBT后脑干坏死的病例引起了人们的关注,PBT可能会比光子治疗增加坏死的风险。我们调查了我院接受PBT治疗颅内恶性肿瘤患儿脑干坏死的发生率。患者和方法:回顾性分析了2013年至2018年使用龙门式同步回旋加速器单拱顶系统进行被动分散PBT治疗的儿童脑肿瘤患者。纳入标准包括21岁或以下的患者,接受最小0.1 cm3的最大脑干剂量为50 Gray相对生物有效性(GyRBE)。根据不良事件通用术语标准(CTCAE) 5.0版(美国国家癌症研究所,Bethesda, Maryland)标准对患者进行脑干“中枢神经系统坏死”评估。结果:58例患者纳入分析。中位年龄为10.3岁。21例(36.2%)患者接受了颅脊髓照射。34例(58.6%)患者接受化疗。处方放射剂量中位数为54 GyRBE。结论:我们的数据表明,使用单拱顶同步回旋加速器被动分散PBT治疗儿童脑干损伤的风险较低。
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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Brainstem Toxicity in Pediatric Patients Treated with Protons Using a Single-vault Synchrocyclotron System.

Purpose: Cranial radiation therapy remains an integral component of curative treatment for pediatric patients with brain tumors. Proton beam radiation therapy (PBT) can limit collateral radiation dose to surrounding normal tissue, thus reducing off-target exposure while maintaining appropriate tumor coverage. While PBT offers significant advantages over photon therapy for pediatric patients with intracranial malignancies, cases of brainstem necrosis after PBT have raised concerns that PBT may pose an increased risk of necrosis over photon therapy. We investigated the incidence of brainstem necrosis at our institution in children treated with PBT for intracranial malignancies.

Patients and methods: Patients with pediatric brain tumor treated with passively scattered PBT, using a gantry-mounted, synchrocyclotron single-vault system between 2013 and 2018, were retrospectively reviewed. Inclusion criteria included patients 21 years of age or younger who received a minimum 0.1 cm3 maximum brainstem dose of 50 Gray relative biological effectiveness (GyRBE). Patients were assessed for "central nervous system necrosis" in the brainstem per the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 (US National Cancer Institute, Bethesda, Maryland) criteria.

Results: Fifty-eight patients were included for analysis. The median age was 10.3 years. Twenty-one (36.2%) patients received craniospinal irradiation. Thirty-four (58.6%) patients received chemotherapy. The median prescription radiation dose was 54 GyRBE. Regarding published dosimetric constraints used at 3 separate proton centers, the goal brainstem D50% <52 GyRBE was exceeded in 23 (40%) patients, but the brainstem Dmax <58 GyRBE was not exceeded in any patients. No patient experienced grade ≥2 brainstem injury. One patient demonstrated radiographic changes consistent with grade 1 toxicity. This patient had myeloablative chemotherapy with tandem stem cell rescue before PBT.

Conclusion: Our data demonstrates a low risk of any brainstem injury in children treated with passively scattered PBT using a single-vault synchrocyclotron.

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来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
期刊最新文献
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