Sequential proton boost after standard chemoradiation for high-grade glioma
Purpose To retrospectively assess the feasibility and safety of a sequential proton boost following conventional chemoradiation in high-grade glioma (HGG). Method and materials Sixty-six consecutive patients with HGG were treated with 50.0Gy photons (50.0-50.4Gy) in 2.0Gy (1.8-2.0Gy) fractions, foll...
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| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
16 October 2017
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| In: |
Radiotherapy and oncology
Year: 2017, Volume: 125, Issue: 2, Pages: 266-272 |
| ISSN: | 1879-0887 |
| DOI: | 10.1016/j.radonc.2017.09.040 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1016/j.radonc.2017.09.040 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0167814017326269 
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| Author Notes: | Sebastian Adeberg, Denise Bernhardt, Semi Ben Harrabi, Matthias Uhl, Angela Paul, Nina Bougatf, Vivek Verma, Andreas Unterberg, Wolfgang Wick, Thomas Haberer, Stephanie E. Combs, Klaus Herfarth, Juergen Debus, Stefan Rieken |
| Summary: | Purpose To retrospectively assess the feasibility and safety of a sequential proton boost following conventional chemoradiation in high-grade glioma (HGG). Method and materials Sixty-six consecutive patients with HGG were treated with 50.0Gy photons (50.0-50.4Gy) in 2.0Gy (1.8-2.0Gy) fractions, followed by a proton boost with 10Gy equivalent (Gy(RBE)) in 2.0 Gy(RBE) fractions. Patients were matched one to one with 66 patients with HGG undergoing conventional radiation therapy (RT) with 60.0Gy photons (59.4-60.0Gy) in 2.0Gy fractions (1.8-2.0Gy). Matching criteria were age, WHO grade, Karnofsky’s performance status, PTV size, temozolomide therapy (each p>0.1). The study assessed progression-free survival (PFS), overall survival (OS), acute treatment-related toxicity (CTCAE v.4.03) and pseudoprogression (RANO criteria). Results Median PFS and OS were similar in both treatment groups (bimodality RT, PFS: 8.8months [2-32months], OS 19.1months [4-41months]; photon-only RT, PFS: 7.2months [2-39months], 20.9months [3-53months]; p=0.430 and p=0.125). The median PTV of the proton boost was significantly smaller than the photon plan PTVs (each p<0.001). Acute toxicity was mild. Toxicity ≥grade 2 was observed in 6 patients (9%) receiving bimodality RT and 9 patients (14%) receiving photon-only RT. Two types of severe adverse events (CTCAE grade 3) occurred solely in the photon-only group: severe increase in intracranial pressure (5%); and generalized seizures (3%). Pseudoprogression was rare, occurring on average 6weeks after radiotherapy, and was balanced in both treatment groups (n=4 each; 8%). Conclusion Delivering a proton boost to significantly smaller target volumes when compared to photon-only plans, yielded comparable progression and survival rates at lower CTCAE grade 3 acute toxicity rates. Pseudoprogression occurred rarely and evenly distributed in both treatment groups. Thus, bimodality RT was at least equivalent regarding outcome and potentially superior with respect to toxicity in patients with HGG. Summary Treating patients with HGG with 50.0Gy photons in 2.0Gy fractions, followed by a proton boost with 10Gy(RBE) in 2.0Gy(RBE) fractions, is safe and feasible. Severe radiation-induced acute toxicity and pseudoprogression were rare in both treatment groups. Therefore, in this clinical setting, combined proton radiotherapy might be beneficial in terms of further risk reduction for treatment-related side effects. Interestingly, treatment volume reduction using a proton boost led to comparable survival and progression rates with decreased severe treatment-related toxicity compared to conventional photon radiotherapy. |
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| Item Description: | Gesehen am 23.04.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1879-0887 |
| DOI: | 10.1016/j.radonc.2017.09.040 |