First experiences in treatment of low-grade glioma grade I and II with proton therapy

Radiation Oncology

Stephanie E Combs¹  Jürgen Debus¹  Klaus Herfarth¹  Kerstin A Kessel¹  Swantje Ecker¹  Stefan Rieken¹  Henrik Hauswald¹ 

[1] Department of Radiation Oncology, University of Heidelberg, INF 400, Heidelberg, 69120, Germany

关键词: Glioma;    Low-grade glioma;    Brain tumor;    Particle therapy;    Ion therapy;    Proton therapy;   

Others  :  1155082
DOI  :  10.1186/1748-717X-7-189

 received in 2012-06-14, accepted in 2012-11-01,  发布年份 2012

【 摘 要 】

Background

To retrospectively assess feasibility and toxicity of proton therapy in patients with low-grade glioma (WHO °I/II).

Patients and methods

Proton beam therapy only administered in 19 patients (median age 29 years; 9 female, 10 male) for low-grade glioma between 2010 and 2011 was reviewed. In 6 cases proton therapy was performed due to tumor progression after biopsy, in 8 cases each due to tumor progression after (partial-) resection, and in 5 cases due to tumor progression after chemotherapy. Median total dose applied was 54 GyE (range, 48,6-54 GyE) in single fractions of median 1.8 GyE. Median clinical target volume was 99 cc (range, 6–463 cc) and treated using median 2 beams (range, 1–2).

Results

Proton therapy was finished as planned in all cases. At end of proton therapy, 13 patients showed focal alopecia, 6 patients reported mild fatigue, one patient with temporal tumor localization concentration deficits and speech errors and one more patient deficits in short-term memory. Four patients did not report any side effects. During follow-up, one patient presented with pseudo-progression showing worsening of general condition and brain edema 1–2 months after last irradiation and restitution after 6 months. In the present MR imaging (median follow-up 5 months; range 0–22 months) 12 patients had stable disease, 2 (1) patients partial (complete) remission, one more patient pseudo-progression (differential diagnosis: tumor progression) 4 weeks after irradiation without having had further follow-up imaging so far, and one patient tumor progression approximately 9 months after irradiation.

Conclusion

Regarding early side effects, mild alopecia was the predominant finding. The rate of alopecia seems to be due to large treatment volumes as well as the anatomical locations of the target volumes and might be avoided by using multiple beams and the gantry in the future. Further evaluations including neuropsychological testing are in preparation.

【 授权许可】

   
2012 Hauswald et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Crocetti E, Trama A, Stiller C, Caldarella A, Soffietti R, Jaal J, Weber DC, Ricardi U, Slowinski J, Brandes A: Epidemiology of glial and non-glial brain tumours in Europe. Oxford, England: European Journal of Cancer; 1990. 2012
• [2]Kleihues P, Burger PC, Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 1993, 3:255-268.
• [3]van den Bent MJ, Wefel JS, Schiff D, Taphoorn MJB, Jaeckle K, Junck L, Armstrong T, Choucair A, Waldman AD, Gorlia T, Chamberlain M, Baumert BG, Vogelbaum MA, Macdonald DR, Reardon DA, Wen PY, Chang SM, Jacobs AH: Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas. Lancet Oncol 2011, 12:583-593.
• [4]Brown PD, Buckner JC, Uhm JH, Shaw EG: The neurocognitive effects of radiation in adult low-grade glioma patients. Neuro Oncol 2003, 5:161-167.
• [5]Beltran C, Roca M, Merchant TE: On the benefits and risks of proton therapy in pediatric craniopharyngioma. Int J Radiat Oncol Biol Phys 2012, 82:e281-e287.
• [6]Athar BS, Paganetti H: Comparison of second cancer risk due to out-of-field doses from 6-MV IMRT and proton therapy based on 6 pediatric patient treatment plans. Radiother Oncol 2011, 98:87-92.
• [7]Galloway TJ, Indelicato DJ, Amdur RJ, Swanson EL, Smith AA, Marcus RB: Second tumors in pediatric patients treated with radiotherapy to the central nervous system. Am J Clin Oncol 2011. [Epub ahead of print] PubMed PMID: 21383606
• [8]Hug EB, Muenter MW, Archambeau JO, DeVries A, Liwnicz B, Loredo LN, Grove RI, Slater JD: Conformal proton radiation therapy for pediatric low-grade astrocytomas. Strahlenther Onkol 2002, 178:10-17.
• [9]Hasegawa A, Mizoe J-E, Tsujii H, Kamada T, Jingu K, Iwadate Y, Nakazato Y, Matsutani M, Takakura K: Experience With Carbon Ion Radiotherapy for WHO Grade 2 Diffuse Astrocytomas. Int J Radiat Oncol Biol Phys 2012, 83:100-106.
• [10]Ruben JD, Dally M, Bailey M, Smith R, McLean CA, Fedele P: Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Phys 2006, 65:499-508.
• [11]Meyzer C, Dhermain F, Ducreux D, Habrand J-L, Varlet P, Sainte-Rose C, Dufour C, Grill J: A case report of pseudoprogression followed by complete remission after proton-beam irradiation for a low-grade glioma in a teenager: the value of dynamic contrast-enhanced MRI. Radiat Oncol 2010, 5:9. BioMed Central Full Text
• [12]Hu LS, Baxter LC, Smith KA, Feuerstein BG, Karis JP, Eschbacher JM, Coons SW, Nakaji P, Yeh RF, Debbins J, Heiserman JE: Relative cerebral blood volume values to differentiate high-grade glioma recurrence from posttreatment radiation effect: direct correlation between image-guided tissue histopathology and localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging measurements. AJNR Am J Neuroradiol 2009, 30:552-558.
• [13]Schlemmer HP, Bachert P, Herfarth KK, Zuna I, Debus J, van Kaick G: Proton MR spectroscopic evaluation of suspicious brain lesions after stereotactic radiotherapy. AJNR Am J Neuroradiol 2001, 22:1316-1324.
• [14]Vöglein J, Tüttenberg J, Weimer M, Gerigk L, Kauczor H-U, Essig M, Weber M-A: Treatment monitoring in gliomas: comparison of dynamic susceptibility-weighted contrast-enhanced and spectroscopic MRI techniques for identifying treatment failure. Invest Radiol 2011, 46:390-400.
• [15]Malkinson FD, Keane JT: Radiobiology of the skin: review of some effects on epidermis and hair. J Invest Dermatol 1981, 77:133-138.