Neuro-oncology · 2013
Technique, outcomes, and acute toxicities in adults treated with proton beam craniospinal irradiation.
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Barney Christian L, Brown Aaron P, Grosshans David R, McAleer Mary Frances, de Groot John F, Puduvalli Vinay, Tucker Susan L, Crawford Cody N, Gilbert Mark R, Brown Paul D, Mahajan Anita
Аннотация
BACKGROUND: Proton craniospinal irradiation (p-CSI) has been proposed to reduce side effects associated with CSI. We evaluated acute toxicities and preliminary clinical outcomes in a series of adults treated with p-CSI.
METHODS: We reviewed medical records for 50 patients (aged 16-63 y) with malignancies of varying histologies treated consecutively with vertebral body-sparing p-CSI at MD Anderson Cancer Center from 2007 to 2011. Median CSI and total boost doses were 30.6 and 54 Gy. Forty patients received chemotherapy, varying by histology. Median follow-up was 20.1 months (range, 0.3-59).
RESULTS: Median doses to the thyroid gland, pituitary gland, hypothalamus, and cochleae were 0.003 Gy-relative biological effectiveness (RBE; range, 0.001-8.5), 36.1 Gy-RBE (22.5-53.0), 37.1 Gy-RBE (22.3-54.4), and 33.9 Gy-RBE (22.2-52.4), respectively. Median percent weight loss during CSI was 1.6% (range, 10% weight loss to 14% weight gain). Mild nausea/vomiting was common (grade 1 = 46%, grade 2 = 20%); however, only 5 patients experienced grade ≥2 anorexia (weight loss >5% baseline weight). Median percent baseline white blood cells, hemoglobin, and platelets at nadir were 52% (range, 13%-100%), 97% (65%-112%), and 61% (10%-270%), respectively. Four patients developed grade ≥3 cytopenias. Overall and progression-free survival rates were 96% and 82%, respectively, at 2 years and 84% and 68% at 5 years.
CONCLUSIONS: This large series of patients treated with p-CSI confirms low rates of acute toxicity, consistent with dosimetric models. Vertebral body-sparing p-CSI is feasible and should be considered as a way to reduce acute gastrointestinal and hematologic toxicity in adults requiring CSI.
METHODS: We reviewed medical records for 50 patients (aged 16-63 y) with malignancies of varying histologies treated consecutively with vertebral body-sparing p-CSI at MD Anderson Cancer Center from 2007 to 2011. Median CSI and total boost doses were 30.6 and 54 Gy. Forty patients received chemotherapy, varying by histology. Median follow-up was 20.1 months (range, 0.3-59).
RESULTS: Median doses to the thyroid gland, pituitary gland, hypothalamus, and cochleae were 0.003 Gy-relative biological effectiveness (RBE; range, 0.001-8.5), 36.1 Gy-RBE (22.5-53.0), 37.1 Gy-RBE (22.3-54.4), and 33.9 Gy-RBE (22.2-52.4), respectively. Median percent weight loss during CSI was 1.6% (range, 10% weight loss to 14% weight gain). Mild nausea/vomiting was common (grade 1 = 46%, grade 2 = 20%); however, only 5 patients experienced grade ≥2 anorexia (weight loss >5% baseline weight). Median percent baseline white blood cells, hemoglobin, and platelets at nadir were 52% (range, 13%-100%), 97% (65%-112%), and 61% (10%-270%), respectively. Four patients developed grade ≥3 cytopenias. Overall and progression-free survival rates were 96% and 82%, respectively, at 2 years and 84% and 68% at 5 years.
CONCLUSIONS: This large series of patients treated with p-CSI confirms low rates of acute toxicity, consistent with dosimetric models. Vertebral body-sparing p-CSI is feasible and should be considered as a way to reduce acute gastrointestinal and hematologic toxicity in adults requiring CSI.