Journal of neuro-oncology · 2026
Proton versus photon VMAT craniospinal irradiation: a retrospective comparison of toxicity and outcomes in solid tumor leptomeningeal carcinomatosis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Lamanilao Gene, Hostler Brianna, Le Tam, Austin Tara, Piccioni David, Schulte Jessica, Shatsky Rebecca, Zhang Xiaojie, Orosco Heather, MacEwan Iain, Steinberg Jeffrey, Beaumont Thomas, Wu Victoria, A Hattangadi-Gluth Jona, Tringale Kathryn R
Аннотация
PURPOSE: Craniospinal irradiation (CSI) is used for leptomeningeal carcinomatosis (LMC), yet comparative data between proton CSI (pCSI) and photon volumetric modulated arc therapy CSI (xCSI) are limited. We evaluated clinical outcomes and longitudinal toxicity profiles following pCSI versus xCSI in patients with solid tumor LMC.
METHODS: We retrospectively identified adults with solid tumor LMC treated with CSI at a single institution from 2020 to 2025. Toxicities were graded per CTCAE v5.0 at baseline, during treatment, and at 1, 3, and 6 months post-CSI. Overall survival (OS) and central nervous system progression-free survival (CNS-PFS) were estimated using Kaplan-Meier methods; Cox models evaluated OS associations.
RESULTS: 45 patients initiated CSI (18 xCSI, 27 pCSI). Grade ≥ 3 lymphopenia during treatment was similar (75% xCSI versus 56% pCSI; p = 0.43), whereas Grade ≥ 3 thrombocytopenia occurred only with xCSI (29% versus 0%; p = 0.04). At 3 months, Grade ≥ 3 lymphopenia was higher with pCSI (79% versus 17%; p = 0.02). Non-hematologic Grade ≥ 3 toxicities were rare. OS did not significantly differ (median 8.5 months pCSI versus 4.8 months xCSI; p = 0.50), nor did CNS-PFS (5.9 versus 3.0 months; p = 0.20). On multivariable analysis, worse OS was associated with higher extracranial tumor burden (HR 2.77, 95% CI, 1.20-6.40) and performance status (HR 2.88, 95% CI, 1.01-8.23), but not modality.
CONCLUSION: No statistically significant modality differences in OS or CNS-PFS were detected; baseline performance status and extracranial burden were associated with OS. VMAT-based CSI represents a practical alternative in settings without protons, with careful monitoring of acute hematologic toxicity.
METHODS: We retrospectively identified adults with solid tumor LMC treated with CSI at a single institution from 2020 to 2025. Toxicities were graded per CTCAE v5.0 at baseline, during treatment, and at 1, 3, and 6 months post-CSI. Overall survival (OS) and central nervous system progression-free survival (CNS-PFS) were estimated using Kaplan-Meier methods; Cox models evaluated OS associations.
RESULTS: 45 patients initiated CSI (18 xCSI, 27 pCSI). Grade ≥ 3 lymphopenia during treatment was similar (75% xCSI versus 56% pCSI; p = 0.43), whereas Grade ≥ 3 thrombocytopenia occurred only with xCSI (29% versus 0%; p = 0.04). At 3 months, Grade ≥ 3 lymphopenia was higher with pCSI (79% versus 17%; p = 0.02). Non-hematologic Grade ≥ 3 toxicities were rare. OS did not significantly differ (median 8.5 months pCSI versus 4.8 months xCSI; p = 0.50), nor did CNS-PFS (5.9 versus 3.0 months; p = 0.20). On multivariable analysis, worse OS was associated with higher extracranial tumor burden (HR 2.77, 95% CI, 1.20-6.40) and performance status (HR 2.88, 95% CI, 1.01-8.23), but not modality.
CONCLUSION: No statistically significant modality differences in OS or CNS-PFS were detected; baseline performance status and extracranial burden were associated with OS. VMAT-based CSI represents a practical alternative in settings without protons, with careful monitoring of acute hematologic toxicity.