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Proton and carbon ions radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy.

颅底脊索瘤的质子和碳离子放疗: 一项基于双粒子和患者定制治疗策略的前瞻性研究。

  • 影响因子:6.99
  • DOI:10.1093/neuonc/noaa067
  • 作者列表:"Iannalfi A","D'Ippolito E","Riva G","Molinelli S","Gandini S","Viselner G","Fiore MR","Vischioni B","Vitolo V","Bonora M","Ronchi S","Petrucci R","Barcellini A","Mirandola A","Russo S","Vai A","Mastella E","Magro G","Maestri D","Ciocca M","Preda L","Valvo F","Orecchia R
  • 发表时间:2020-03-20
Abstract

BACKGROUND:The aim of this study is to evaluate results in terms of local control (LC), overall survival (OS) and toxicity profile and to better identify factors influencing clinical outcome of skull base chordoma treated with proton therapy (PT) and carbon ion therapy (CIRT). METHODS:We prospectively collected and analyzed data of 135 patients treated between 11/2011 and 12/2018. Total prescription dose in PT group (70 patients) and CIRT group (65 patients) was 74 Gy(RBE) delivered in 37 fractions and 70.4 Gy(RBE) delivered in 16 fractions, respectively (CIRT in unfavorable patients). LC and OS were evaluated using the Kaplan-Meier method. Univariate and multivariate analyses were performed, to identify prognostic factors on clinical outcomes. RESULTS:After a median follow-up of 44 (range, 6-87) months, 14 (21%) and 8 (11%) local failures were observed in CIRT and PT group, respectively. 5-year LC rate was 71% in CIRT cohort and 84% in PT cohort. The estimated 5-year OS rate in CIRT and PT group was 82% and 83%, respectively. On multivariate analysis, Gross Tumor Volume (GTV), optic pathways and/or brainstem compression and dose coverage are independent prognostic factors of local failure risk. High rate toxicity ≥ grade 3 was reported in 11% of patients. CONCLUSIONS:Particle radiotherapy is an effective treatment for skull base chordoma with acceptable late toxicity. GTV, optic pathways and/or brainstem compression and target coverage were independent prognostic factors for LC.

摘要

背景: 本研究的目的是评估局部控制 (LC) 、总生存期 (OS) 的结果和毒性特征,以便更好地确定影响质子治疗 (PT) 和碳离子治疗 (CIRT) 颅底脊索瘤临床结局的因素。 方法: 我们前瞻性地收集和分析了 135 例在 11/2011 和 12/2018 之间接受治疗的患者的数据。PT 组 (70 例) 和 CIRT 组 (65 例) 的总处方剂量为 74 Gy (RBE) 分 37 次给药,70.4 Gy (RBE) 分 16 次给药, 分别 (不良患者中的 CIRT)。采用 Kaplan-Meier 法评价 LC 和 OS。进行单变量和多变量分析,以确定临床结局的预后因素。 结果: 中位随访 44 (范围,6-87) 个月后,CIRT 组和 PT 组分别观察到 14 (21%) 和 8 (11%) 个局部失败。CIRT 队列的 5 年 LC 率为 71%,PT 队列为 84%。CIRT 和 PT 组的估计 5 年 OS 率分别为 82% 和 83%。在多变量分析中,大体肿瘤体积 (GTV) 、视路和/或脑干压缩和剂量覆盖是局部失败风险的独立预后因素。11% 的患者报告了 ≥ 3 级的高发生率毒性。 结论: 粒子放射治疗是治疗颅底脊索瘤的有效方法,其晚期毒性尚可。GTV 、视路和/或脑干压迫和靶区覆盖是 LC 的独立预后因素。

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