Long-term outcomes following proton therapy for non-metastatic central nervous system germinoma in children and adolescents.

Autor: Brisson RJ; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States., Indelicato DJ; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States. Electronic address: dindelicato@floridaproton.org., Bradley JA; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States., Aldana PR; Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, United States., Klawinski D; Department of Pediatrics, Nemours Children's Specialty Clinic, Jacksonville, FL, United States., Cassidy V; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States., Morris CG; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States., Mailhot Vega RB; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Sep; Vol. 198, pp. 110371. Date of Electronic Publication: 2024 Jun 08.
DOI: 10.1016/j.radonc.2024.110371
Abstrakt: Background/purpose: Radiation is a key component in the treatment of central nervous system pure germinoma (PG) in children and adolescents. Proton therapy (PT) improves normal tissue sparing and potentially reduces adverse effects (AE). The aim of this study was to present the largest single institution experience utilizing PT for the management of PG.
Materials Methods: We enrolled 35 non-metastatic patients with PG that were treated with PT at our institution between July 2007 - September 2021. Most received induction chemotherapy (n = 31, 89 %) and whole ventricular irradiation with an involved field boost (n = 29, 83 %). The most common total dose was 30 CGE (n = 18, 51.4 %). We utilized the cumulative incidence method to estimate local control (LC), freedom from distant metastases (FFDM), freedom from progression (FFP), and overall survival (OS). Treatment related toxicity was assessed per CTCAE version 5.
Results: Median follow-up was 6.2 years (range, 0.9---15.2). The 10-year Kaplan-Meier estimates for LC, FFDM, FFP, and OS were 100 %, 100 %, 100 %, and 94 % respectively. The most common AE were hearing impairment requiring hearing aids (n = 3), transient hypersomnia requiring medication (n = 3), and new onset endocrinopathy (n = 1). Of the 23 evaluable patients ≥ 18 years old at last follow-up, 8 were high school graduates/in college, 8 college graduates, and 7 others gainfully employed.
Conclusions: When utilized in modern multimodality treatment of non-metastatic PG, the precise dosimetry of PT does not compromise disease control. Although serious radiation side effects are rare, the 100% cure rate supports further investigation into selective radiation dose and volume de-escalation.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier B.V.)
Databáze: MEDLINE
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