Outcomes following proton therapy for pediatric esthesioneuroblastoma.

Autor: Drescher NR; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA., Indelicato DJ; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA., Dagan R; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA., Bradley JA; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA., Holtzman AL; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA., Mailhot Vega RB; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA., Aldana PR; Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, USA., Sandler ES; Department of Pediatrics, Nemours Children's Specialty Clinic, Jacksonville, Florida, USA., Morris CG; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA., Mendenhall WM; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2024 Feb; Vol. 71 (2), pp. e30793. Date of Electronic Publication: 2023 Nov 29.
DOI: 10.1002/pbc.30793
Abstrakt: Background: Pediatric esthesioneuroblastoma (EN) can infiltrate skull base anatomy, presenting challenges due to high radiation doses and pediatric tissue sensitivity. This study reports outcomes of pediatric EN treated with proton radiotherapy (PT).
Procedure: Using an IRB-approved prospective outcomes registry, we evaluated patient, tumor, and treatment-related variables impacting disease control and toxicity in pediatric nonmetastatic EN treated with modern multimodality therapy, including PT.
Results: Fifteen consecutive patients (median age 16) comprising Kadish stage B (n = 2), C (n = 9), and D (n = 4) tumors were assessed, including six with intracranial involvement, four with cranial nerve deficits, and four with cervical lymphadenopathy. Before radiation, two had subtotal and 13 had gross total resections (endoscopic or craniofacial). Two underwent neck dissection. Eleven received chemotherapy before radiation (n = 5), concurrent with radiation (n = 4), or both (n = 2). Median total radiation dose (primary site) was 66 Gy/CGE for gross disease and 54 Gy/CGE (cobalt Gray equivalent) for microscopic disease. Median follow-up was 4.8 years. No patients were lost to follow-up. Five-year disease-free and overall survival rates were 86% (no local or regional recurrences). Two patients developed vertebral metastases and died. Two required a temporary feeding tube for oral mucositis/dysphagia. Late toxicities included symptomatic retinopathy, major reconstructive surgery, cataracts, chronic otitis media, chronic keratoconjunctivitis, hypothyroidism, and in-field basal cell skin cancer.
Conclusions: A multimodality approach for pediatric EN results in excellent local control. Despite the moderate-dose PT, serious radiation toxicity was observed; further dose and target volume reductions may benefit select patients. Longer follow-up and comparative data from modern photon series are necessary to fully characterize any relative PT advantage.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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