Proton beam radiosurgery: early clinical results
| Autor: | Daniel M. Trifiletti, Janet Leon, Laura A. Vallow, Austin Hadley, Jennifer L. Peterson |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Time Factors medicine.medical_treatment Kaplan-Meier Estimate Radiosurgery Malignancy Systemic therapy Necrosis Young Adult Breast cancer Renal cell carcinoma Proton Therapy medicine Humans Radiology Nuclear Medicine and imaging Treatment Failure Radiation Injuries Lung cancer Aged Proportional Hazards Models Retrospective Studies Aged 80 and over Salvage Therapy Brain Neoplasms business.industry Melanoma Brain Cancer Middle Aged medicine.disease Survival Rate Editorial Oncology Multivariate Analysis Female Radiology business Follow-Up Studies |
| Zdroj: | Translational Cancer Research |
| ISSN: | 2219-6803 2218-676X |
| Popis: | To report the first series of proton stereotactic radiosurgery (SRS) for the treatment of patients with single or multiple brain metastases, including failure patterns, survival outcomes, and toxicity analysis.This was a single-institution, retrospective study of 815 metastases from 370 patients treated with proton SRS between April 1991 and November 2016. Cumulative incidence estimates of local failure, distant brain failure, and pathologically confirmed radionecrosis and Kaplan-Meier estimates of overall survival were calculated. Fine and Gray and Cox regressions were performed to ascertain whether clinical and treatment factors were associated with the described endpoints.The median follow-up from proton SRS was 9.2 months. The 6- and 12-month estimates of local failure, distant brain failure, and overall survival were 4.3% (95% confidence interval [CI] 3.0%-5.9%) and 8.5% (95% CI 6.7%-10.6%), 39.1% (95% CI 34.1%-44.0%) and 48.2% (95% CI 43.0%-53.2%), and 76.0% (95% CI 71.3%-80.0%) and 51.5% (95% CI 46.3%-56.5%), respectively. The median survival was 12.4 months (95% CI 10.8-14.0 months) after proton SRS. The most common symptoms were low-grade fatigue (12.5%), headache (10.0%), motor weakness (6.2%), seizure (5.8%), and dizziness (5.4%). The rate of pathologically confirmed radionecrosis at 12 months was 3.6% (95% CI 2.0%-5.8%), and only target volume was associated on multivariate analysis (subdistribution hazard ratio 1.13, 95% CI 1.0-1.20).To the best of our knowledge, this is the first reported series of proton SRS for the management of brain metastases. Moderate-dose proton SRS is well tolerated and can achieve good local control outcomes, comparable to those obtained with conventional photon SRS strategies. Although proton SRS remains resource-intensive, future strategies evaluating its selective utility in patients who would benefit most from integral dose reduction should be explored. |
| Databáze: | OpenAIRE |
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