Proton versus photon craniospinal irradiation for adult medulloblastoma: A dosimetric, toxicity, and exploratory cost analysis.

Autor:	Breen WG; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Geno CS; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Waddle MR; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Qian J; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Harmsen WS; Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA., Burns TC; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA., Sener UT; Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA., Ruff MW; Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA., Neth BJ; Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA., Uhm JH; Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA., Routman DM; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Yan E; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Kruse JJ; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Laack NN; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Brown PD; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Mahajan A; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk:	angličtina
Zdroj:	Neuro-oncology advances [Neurooncol Adv] 2024 Mar 08; Vol. 6 (1), pp. vdae034. Date of Electronic Publication: 2024 Mar 08 (Print Publication: 2024).
DOI:	10.1093/noajnl/vdae034
Abstrakt:	Background: This study aimed to determine whether proton craniospinal irradiation (CSI) decreased the dose to normal tissue and resulted in less toxicity than photon CSI for adult patients. Methods: This single-institution retrospective analyzed differences in radiation doses, acute toxicity, and cost between proton and CSI for adult medulloblastoma patients. Results: Of 39 total patients, 20 were treated with photon CSI prior to 2015, and 19 were treated with proton CSI thereafter. Median age was 28 years (range 18-66). The molecular subtype was most commonly sonic hedgehog (68%). Patients most commonly received 36 Gy CSI in 20 fractions with a boost to 54-55.8 Gy (92%). Proton CSI delivered significantly lower mean doses to cochleae, lacrimal glands, lens, parotid glands, pharyngeal constrictors, esophagus, lungs, liver, and skin (all P  < .001). Patients receiving proton CSI had significantly lower rates of acute dysphagia of any grade (5% versus 35%, P  = .044) and decreased median weight loss during radiation (+1.0 versus -2.8 kg, P  = .011). Weight loss was associated with acute hospitalization ( P  = .009). Median follow-up was 2.9 and 12.9 years for proton and photon patients, respectively, limiting late toxicity and outcome comparisons. At the last follow-up, 5 photon patients had died (2 of progressive disease, 3 without recurrence ages 41-63) and 21% had experienced major cardiovascular events. At 10 years, 89% were alive and 82% were recurrence free. Conclusions: This study demonstrates dosimetric improvements with proton CSI, potentially leading to decreased acute toxicity including dysphagia and weight loss during treatment. Competing Interests: None of the authors reported conflicts of interest. (© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)
Databáze:	MEDLINE
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