Outcome after proton beam therapy versus photon-based radiation therapy in childhood-onset craniopharyngioma patients—results of KRANIOPHARYNGEOM 2007

Frontiers in Oncology

Oncology

Martin Bischoff¹  Beate Timmermann²  Gabriele Calaminus³  Julia Beckhaus⁴  Svenja Boekhoff⁴  Carsten Friedrich⁴  Hermann L. Müller⁴  Panjarat Sowithayasakul⁵  Semi B. Harrabi⁶  Chiara Valentini⁷  Mechthild Krause⁸  Brigitte Bison⁹  Maria Eveslage^1,10 

[1] Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany;Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ) and German Cancer Consortium (DKTK), Essen, Germany;Department of Pediatric Hematology/Oncology, University of Bonn Medical Center, Bonn, Germany;Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany;Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany;Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand;Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany;Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;National Center for Tumor Diseases (NCT) Dresden with German Cancer Research Center (DKFZ), University Hospital and Faculty of Medicine Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany;German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dresden, Germany;Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany;Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany;

关键词: craniopharyngioma;    proton beam therapy;    irradiation;    quality of life;    hypothalamus;    obesity;    photon-based radiation therapy;    survival;   

DOI  :  10.3389/fonc.2023.1180993

 received in 2023-03-06, accepted in 2023-10-09,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundProton beam therapy (PBT) is being increas16ingly used to treat residual craniopharyngioma (CP) after hypothalamus-sparing surgery. Compared to photon-based radiation therapy (XRT) with PBT, less irradiation in the penumbra reduces the scattered dose to critical organs neighboring but outside the area of treatment, minimizing the risk of sequelae.Patients and methodsBetween 2007 and 2019, 99 of 290 (34%) childhood-onset CP patients recruited in KRANIOPHARYNGEOM 2007 received external radiation therapy (RT) (65% PBT, 35% XRT). Outcome was analyzed in terms of survival, endocrinological and anthropometric parameters (BMI and height SDS), quality of life (QoL using PEDQOL), and functional capacity (FMH) with special regard to irradiation technique.ResultsPBT became predominant (used in 43% and 72% of all irradiated patients registered within the first and second halves of the recruitment period, between 2008 and 2013 and 2013 and 2018, respectively). Five-year event-free survival rates after PBT or XRT were comparable (92% ± 4% vs. 91% ± 4%, p = 0.42) and higher than for the whole cohort since diagnosis, including non-RT patients (37% ± 4%). Radiation doses to the hypothalamus and pituitary did not differ between PBT and XRT. Endocrine deficits due to disturbances of the hypothalamic-pituitary axis (HPA) were already common before irradiation. During the first 5 years after CP diagnosis/RT, no differences between PBT, XRT, and non-RT CP patients concerning functional capacity and anthropometric parameters have been obtained. Only for the PEDQOL domain “physical function”, parental-assessed QoL was lower 12 months after PBT versus XRT or non-RT patients.ConclusionQoL, functional capacity, degree of obesity, and endocrinopathy varied over time from diagnosis, but by 5 years, there was no significant difference between PBT and XRT upfront or delayed, nor was there any compromise in historic survival rates, which remained high >90%. RT of any type is extremely effective at stabilizing disease after hypothalamic-sparing surgery. The purported specific benefits of PBT-reducing sequelae are not proven in this study where the organ of critical interest is itself diseased, increasing an urgent need to better address and treat the tumor-induced endocrine harm from diagnosis in dedicated pituitary services. Other hypothesized benefits of PBT versus XRT on vascular events and secondary cancers await longer comparison.Clinical trial registration numberhttps://clinicaltrials.gov/study/, identifier NCT01272622.

【 授权许可】

Unknown   
Copyright © 2023 Friedrich, Boekhoff, Bischoff, Beckhaus, Sowithayasakul, Calaminus, Eveslage, Valentini, Bison, Harrabi, Krause, Timmermann and Müller