BACKGROUND The objective of this study was to evaluate the outcomes of patients with high-grade glioma who received treatment with particle radiotherapy. METHODS Between June 2015 and October 2018, 50 consecutive and nonselected patients with glioblastoma multiforme (n = 34) or anaplastic glioma (n = 16) were treated at the Shanghai Proton and Heavy Ion Center. Twenty-four patients received proton radiotherapy (at a dose of 60 gray-equivalents in 30 daily fractions), and 26 patients received proton radiotherapy plus a carbon-ion radiotherapy (CIRT) boost in various dose-escalating schemes. All patients received temozolomide because of their age or their O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. Progression-free survival (PFS) and overall survival (OS) rates, as well as treatment-induced toxicities, were analyzed. RESULTS At a median follow-up of 14.3 months (range, 4.8-39.6 months), the 12-month and 18-month OS rates were 87.8% (95% CI, 77.6%-98.0%) and 72.8% (95% CI, 56.7%-88.9%), respectively, and the 12-month and 18-month PFS rates were 74.2% (95% CI, 60.9%-87.5%) and 59.8% (95% CI, 43.1%-76.5%), respectively. Univariate analyses revealed that age (>50 vs ≤50 years), World Health Organization grade (3 vs 4), and Karnofsky performance status (>80 vs ≤80) were significant prognosticators for OS, and IDH mutation and World Health Organization grade were significant for predicting PFS. Furthermore, MGMT promoter methylation, performance status, and age showed a trend toward predicting PFS. No significant predictive factors for PFS or OS were identified in multivariate analyses. Twenty-nine patients experienced grade 1 treatment-related acute adverse effects, and 11 developed grade 1 (n = 6) or grade 2 (n = 5) late adverse effect of radiation-induced brain necrosis. No grade 3, 4, or 5 toxicities were observed. CONCLUSIONS Particle radiotherapy produced 18-month OS and PFS rates of 72.8% and 59.8%, respectively, with acceptable adverse effects in patients with high-grade glioma. Particle radiotherapy at a dose ≥60 gray-equivalents appears to be safe and potentially effective.

中文翻译：

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粒子放射疗法治疗恶性神经胶质瘤：在上海质子重离子中心的早期经验。

背景技术这项研究的目的是评估接受粒子放射疗法治疗的高级别胶质瘤患者的预后。方法2015年6月至2018年10月，在上海质子和重离子中心对50例连续性和非选择性多形性胶质母细胞瘤（n = 34）或间变性胶质瘤（n = 16）的患者进行了治疗。24例患者接受了质子放疗（每天30次，剂量相当于60灰度当量），而26例患者接受了各种剂量递增方案的质子放疗加碳离子放疗（CIRT）增强。所有患者因年龄或O-6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化状态而接受替莫唑胺。分析了无进展生存期（PFS）和总生存期（OS）率以及治疗引起的毒性。结果在平均14.3个月（范围4.8-39.6个月）中，12个月和18个月OS率分别为87.8％（95％CI，77.6％-98.0％）和72.8％（95％CI）分别为56.7％-88.9％）和12个月和18个月的PFS率为74.2％（95％CI，60.9％-87.5％）和59.8％（95％CI，43.1％-76.5％），分别。单因素分析显示，年龄（> 50 vs≤50岁），世界卫生组织等级（3 vs 4）和卡诺夫斯基绩效状态（> 80 vs≤80）是OS的重要预后因素，IDH突变和世界卫生组织等级是对于预测PFS具有重要意义。此外，MGMT启动子甲基化，功能状态和年龄显示出预测PFS的趋势。在多变量分析中未发现PFS或OS的重要预测因素。29名患者经历了1级与治疗相关的急性不良反应，而11名患者出现了辐射诱发性脑坏死的1级（n = 6）或2级（n = 5）晚期不良反应。没有观察到3、4或5级毒性。结论粒子放射疗法治疗18个月OS和PFS的发生率分别为72.8％和59.8％，对高级别神经胶质瘤患者的不良反应尚可。剂量≥60灰当量的粒子放射疗法似乎是安全的，并且可能有效。