Fractionated Proton Beam Therapy for Acoustic Neuromas: Tumor Control and Hearing Preservation.

Autor:	Barnes CJ; Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA., Bush DA; Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA., Grove RI; Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA., Loredo LN; Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA., Slater JD; Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
Jazyk:	angličtina
Zdroj:	International journal of particle therapy [Int J Part Ther] 2018 Spring; Vol. 4 (4), pp. 28-36. Date of Electronic Publication: 2018 Jul 26.
DOI:	10.14338/IJPT-14-00014.1
Abstrakt:	Purpose: This prospective cohort evaluated patients with acoustic neuroma treated with proton irradiation at Loma Linda University Medical Center. A dose of 50.4 Gy in 28 fractions was given to improve hearing preservation while maintaining tumor control. Patients and Methods: Ninety-five patients were treated from March 1991 to March 2008. Fractionated proton radiotherapy at daily doses of 1.8 Gy was employed. Patients were treated to 1 of 3 total doses: 59.4 Gy, used initially for patients without serviceable hearing; 54 Gy, used for patients with serviceable hearing through October 2000; and 50.4 Gy used since 2001 for patients with serviceable hearing. Survival and local control were calculated using the Kaplan-Meier method. Logistic regression analysis was preformed comparing dose, tumor size, and tumor location with hearing preservation. Results: Ninety-four patients were assessable; the median follow-up was 64 months. Five-year local control rates for the 59.4 Gy, 54 Gy, and 50.4 Gy groups were 95%, 97%, and 92%, respectively ( P = .80); the overall 10-year actuarial control rate was 90%. Cranial nerve injuries occurred in <5% in all groups. Four-year actuarial rates of hearing preservation were maintained in 44% of patients treated with 54 Gy and 64% treated with 50.4 Gy ( P = .284). On multivariate analysis, initial tumor diameter (≤1.5 cm) was found to be a prognostic factor for maintaining serviceable hearing in both groups ( P = .011). Conclusions: Fractionated proton therapy of 50.4 Gy offers excellent local control and minimal cranial nerve toxicities. Improved rates of hearing preservation that are comparable with radiosurgery were seen with 50.4 Gy compared with higher doses, although this did not reach significance. Maintaining hearing was found to be associated with smaller initial tumor size. Competing Interests: Conflict of Interest Statement: Actual or potential conflicts of interest do not exist for any of the listed authors. (© Copyright 2018 International Journal of Particle Therapy.)
Databáze:	MEDLINE
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