Clinical outcomes in a large pediatric cohort of patients with ependymoma treated with proton radiotherapy

被引:14
作者
Patteson, Brooke E. [1 ]
Baliga, Sujith [1 ,3 ]
Bajaj, Benjamin V. M. [1 ]
MacDonald, Shannon M. [1 ]
Yeap, Beow Y. [4 ]
Gallotto, Sara L. [1 ]
Giblin, Megan J. [1 ]
Weyman, Elizabeth A. [1 ]
Ebb, David H. [2 ]
Huang, Mary S. [2 ]
Jones, Robin M. [2 ]
Tarbell, Nancy J. [1 ]
Yock, Torunn, I [1 ]
机构
[1] Harvard Med Sch, Dept Radiat Oncol, Massachusetts Gen Hosp, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Pediat Hematol Oncol, Boston, MA 02114 USA
[3] Ohio State Univ, Dept Radiat Oncol, Wexner Med Ctr, Columbus, OH 43210 USA
[4] Harvard Med Sch, Dept Med, Massachusetts Gen Hosp, Boston, MA 02114 USA
关键词
pediatric ependymoma; proton; radiation; BRAIN-STEM; POSTOPERATIVE CHEMOTHERAPY; INTRACRANIAL EPENDYMOMAS; RADIATION-THERAPY; BEAM THERAPY; CHILDREN; CHILDHOOD; CANCER; SURVIVAL; TUMORS;
D O I
10.1093/neuonc/noaa139
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background. Treatment for pediatric ependymoma includes surgical resection followed by local radiotherapy (RT). Proton RT (PRT) enables superior sparing of critical structures compared with photons, with potential to reduce late effects. We report mature outcomes, patterns of failure, and predictors of outcomes in patients treated with PRT. Methods. One hundred fifty patients (<22 y) with World Health Organization grades II/III ependymoma were treated with PRT between January 2001 and January 2019 at Massachusetts General Hospital. Demographic, tumor, and treatment-related characteristics were analyzed. Event-free survival (EFS), overall survival (OS), and local control (LC) were assessed. Results. Median follow-up was 6.5 years. EFS, OS, and LC for the intracranial cohort ( n = 145) at 7 years were 63.4%, 82.6%, and 76.1%. Fifty-one patients recurred: 26 (51.0%) local failures, 19 (37.3%) distant failures, and 6 (11.8%) synchronous failures. One hundred sixteen patients (77.3%) underwent gross total resection (GTR), 5 (3.3%) underwent near total resection (NTR), and 29 (19.3%) underwent subtotal resection (STR). EFS for the intracranial cohort at 7 years for GTR/NTR and STR was 70.3% and 35.2%. With multivariate analysis, the effect of tumor excision persisted after controlling for tumor location. There was no adverse effect on disease control if surgery to RT interval was within 9 weeks of GTR/NTR. Conclusion. PRT is effective and safe in pediatric ependymoma. Similar to previous studies, GTR/NTR was the most important prognostic factor. Intervals up to 9 weeks from surgery to PRT did not compromise disease outcomes. There was no LC benefit between patients treated with >54 Gray relative biological effectiveness (Gy(RBE)) versus <54 Gy(RBE).
引用
收藏
页码:156 / 166
页数:11
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