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Transitioning from conventional photon therapy to proton therapy for primary brain tumors

Ek, Hanna ; Fagerström Kristensen, Ingrid LU ; Stenberg, Lars LU ; Kinhult, Sara LU ; Benedek, Hunor LU ; Ek, Simon LU ; Engelholm, Svend Aage ; Engelholm, Silke and Munck Af Rosenschöld, Per LU orcid (2023) In Acta oncologica (Stockholm, Sweden) 62(4). p.391-399
Abstract

Introduction: Proton radiation therapy (PT) has become a treatment option alongside photon therapy (XRT) for lower-grade gliomas (LGG). In this single-institution retrospective study, we investigate the patient characteristics and treatment outcomes, including pseudo-progression (PsP), for LGG patients selected for PT. Method: Adult patients with grade 2–3 glioma consecutively treated with radiotherapy (RT) from May 2012 to December 2019 were retrospectively included in this cohort study. Tumor characteristics and treatment data were collected. The groups treated with PT and XRT were compared regarding treatment characteristics, side effects, occurrence of PsP, and survival outcomes. PsP was defined as new or growing lesions followed by... (More)

Introduction: Proton radiation therapy (PT) has become a treatment option alongside photon therapy (XRT) for lower-grade gliomas (LGG). In this single-institution retrospective study, we investigate the patient characteristics and treatment outcomes, including pseudo-progression (PsP), for LGG patients selected for PT. Method: Adult patients with grade 2–3 glioma consecutively treated with radiotherapy (RT) from May 2012 to December 2019 were retrospectively included in this cohort study. Tumor characteristics and treatment data were collected. The groups treated with PT and XRT were compared regarding treatment characteristics, side effects, occurrence of PsP, and survival outcomes. PsP was defined as new or growing lesions followed by either decrease or stabilization during a 12 month-period with no treatment. Results: Out of 143 patients meeting the inclusion criteria, 44 were treated with PT, 98 with XRT and one with mixed PT + XRT. The patients receiving PT were younger, had a lower tumor grade, more oligodendrogliomas and received a lower mean brain and brainstem dose. PsP was observed in 21 out of 126 patients, with no difference between XRT and PT (p =.38). The rate of fatigue in immediate connection to RT (zero to three months after) was higher for XRT than for PT (p =.016). The PT patients had a significantly better PFS and OS than the XRT patients (p =.025 and.035), but in multivariate analysis radiation modality was non-significant. Higher average dose to both brain and brainstem was associated with inferior PFS and OS (p <.001). Median follow-up time were 69 months and 26 months for XRT and PT patients, respectively. Conclusion: Contrary to previous studies, there was no difference in risk of PsP for XRT and PT. PT was associated with lower rates of fatigue <3 months after RT. The superior survival outcomes for PT indicates that the patients with the best prognosis were referred to PT.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Humans, Proton Therapy/adverse effects, Brain Neoplasms/pathology, Retrospective Studies, Cohort Studies, Glioma/radiotherapy
in
Acta oncologica (Stockholm, Sweden)
volume
62
issue
4
pages
9 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85159708280
  • pmid:37203198
  • pmid:37203198
ISSN
1651-226X
DOI
10.1080/0284186X.2023.2200150
language
English
LU publication?
yes
id
6c9f2bdb-946d-499c-a64f-8c47e509ff9f
date added to LUP
2023-07-05 22:10:26
date last changed
2024-04-19 23:16:03
@article{6c9f2bdb-946d-499c-a64f-8c47e509ff9f,
  abstract     = {{<p>Introduction: Proton radiation therapy (PT) has become a treatment option alongside photon therapy (XRT) for lower-grade gliomas (LGG). In this single-institution retrospective study, we investigate the patient characteristics and treatment outcomes, including pseudo-progression (PsP), for LGG patients selected for PT. Method: Adult patients with grade 2–3 glioma consecutively treated with radiotherapy (RT) from May 2012 to December 2019 were retrospectively included in this cohort study. Tumor characteristics and treatment data were collected. The groups treated with PT and XRT were compared regarding treatment characteristics, side effects, occurrence of PsP, and survival outcomes. PsP was defined as new or growing lesions followed by either decrease or stabilization during a 12 month-period with no treatment. Results: Out of 143 patients meeting the inclusion criteria, 44 were treated with PT, 98 with XRT and one with mixed PT + XRT. The patients receiving PT were younger, had a lower tumor grade, more oligodendrogliomas and received a lower mean brain and brainstem dose. PsP was observed in 21 out of 126 patients, with no difference between XRT and PT (p =.38). The rate of fatigue in immediate connection to RT (zero to three months after) was higher for XRT than for PT (p =.016). The PT patients had a significantly better PFS and OS than the XRT patients (p =.025 and.035), but in multivariate analysis radiation modality was non-significant. Higher average dose to both brain and brainstem was associated with inferior PFS and OS (p &lt;.001). Median follow-up time were 69 months and 26 months for XRT and PT patients, respectively. Conclusion: Contrary to previous studies, there was no difference in risk of PsP for XRT and PT. PT was associated with lower rates of fatigue &lt;3 months after RT. The superior survival outcomes for PT indicates that the patients with the best prognosis were referred to PT.</p>}},
  author       = {{Ek, Hanna and Fagerström Kristensen, Ingrid and Stenberg, Lars and Kinhult, Sara and Benedek, Hunor and Ek, Simon and Engelholm, Svend Aage and Engelholm, Silke and Munck Af Rosenschöld, Per}},
  issn         = {{1651-226X}},
  keywords     = {{Adult; Humans; Proton Therapy/adverse effects; Brain Neoplasms/pathology; Retrospective Studies; Cohort Studies; Glioma/radiotherapy}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{391--399}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta oncologica (Stockholm, Sweden)}},
  title        = {{Transitioning from conventional photon therapy to proton therapy for primary brain tumors}},
  url          = {{http://dx.doi.org/10.1080/0284186X.2023.2200150}},
  doi          = {{10.1080/0284186X.2023.2200150}},
  volume       = {{62}},
  year         = {{2023}},
}