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Analysis of safety and efficacy of proton radiotherapy for IDH-mutated glioma WHO grade 2 and 3

PURPOSE: Proton beam radiotherapy (PRT) has been demonstrated to improve neurocognitive sequelae particularly. Nevertheless, following PRT, increased rates of radiation-induced contrast enhancements (RICE) are feared. How safe and effective is PRT for IDH-mutated glioma WHO grade 2 and 3? METHODS: W...

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Detalles Bibliográficos
Autores principales: Eichkorn, Tanja, Lischalk, Jonathan W., Hörner-Rieber, Juliane, Deng, Maximilian, Meixner, Eva, Krämer, Anna, Hoegen, Philipp, Sandrini, Elisabetta, Regnery, Sebastian, Held, Thomas, Harrabi, Semi, Jungk, Christine, Herfarth, Klaus, Debus, Jürgen, König, Laila
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227167/
https://www.ncbi.nlm.nih.gov/pubmed/36598613
http://dx.doi.org/10.1007/s11060-022-04217-y
Descripción
Sumario:PURPOSE: Proton beam radiotherapy (PRT) has been demonstrated to improve neurocognitive sequelae particularly. Nevertheless, following PRT, increased rates of radiation-induced contrast enhancements (RICE) are feared. How safe and effective is PRT for IDH-mutated glioma WHO grade 2 and 3? METHODS: We analyzed 194 patients diagnosed with IDH-mutated WHO grade 2 (n = 128) and WHO grade 3 (n = 66) glioma who were treated with PRT from 2010 to 2020. Serial clinical and imaging follow-up was performed for a median of 5.1 years. RESULTS: For WHO grade 2, 61% were astrocytoma and 39% oligodendroglioma while for WHO grade 3, 55% were astrocytoma and 45% oligodendroglioma. Median dose for IDH-mutated glioma was 54 Gy(RBE) [range 50.4–60 Gy(RBE)] for WHO grade 2 and 60 Gy(RBE) [range 54–60 Gy(RBE)] for WHO grade 3. Five year overall survival was 85% in patients with WHO grade 2 and 67% in patients with WHO grade 3 tumors. Overall RICE risk was 25%, being higher in patients with WHO grade 2 (29%) versus in patients with WHO grade 3 (17%, p = 0.13). RICE risk increased independent of tumor characteristics with older age (p = 0.017). Overall RICE was symptomatic in 31% of patients with corresponding CTCAE grades as follows: 80% grade 1, 7% grade 2, 13% grade 3, and 0% grade 3 + . Overall need for RICE-directed therapy was 35%. CONCLUSION: These data demonstrate the effectiveness of PRT for IDH-mutated glioma WHO grade 2 and 3. The RICE risk differs with WHO grading and is higher in older patients with IDH-mutated Glioma WHO grade 2 and 3. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-022-04217-y.