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Goliot N, Mohssine S, Stefan D, Leclerc A, Emery E, Riverain J, Missohou F, Geffrelot J, Kao W, Valable S, Balosso J, Lesueur P. PROTON THERAPY FOR ADULT-TYPE DIFFUSE GLIOMA: A SYSTEMATIC REVIEW. Crit Rev Oncol Hematol 2024:104501. [PMID: 39251047 DOI: 10.1016/j.critrevonc.2024.104501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND We conducted a systematic review to evaluate outcomes and toxicities associated with proton therapy in the treatment of adult-type diffuse glioma. METHODS Following PRISMA guidelines, we searched PubMed for both prospective and retrospective studies on proton therapy for adult diffuse gliomas, including low-grade gliomas and glioblastomas. Survival and toxicity outcomes were reported separately for these glioma types. RESULTS Twelve studies from 2013 to 2023 were selected, comprising 3 prospective and 9 retrospective studies. The analysis covered 570 patients with low-grade gliomas and 240 patients with glioblastoma or WHO grade 4 gliomas. Proton therapy was found to be comparable to conventional radiotherapy in terms of survival outcomes. Its main advantage is the ability to minimize radiation exposure to healthy tissues. DISCUSSION Proton therapy offers comparable survival outcomes to conventional radiotherapy for adult diffuse gliomas and may enhance treatment tolerance, especially regarding neurocognitive function. A major limitation of this review is the predominance of retrospective studies. Future research should ensure rigorous patient selection and adhere to the latest WHO 2021 classification.
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Affiliation(s)
- Nicolas Goliot
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France; Cyclhad, Normandy proton therapy center, 14000 Caen, France; Normandie Univ., UNICAEN, CNRS, ISTCT, GIP CYCERON, 14000 Caen, France.
| | - Selim Mohssine
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France; Cyclhad, Normandy proton therapy center, 14000 Caen, France; Normandie Univ., UNICAEN, CNRS, ISTCT, GIP CYCERON, 14000 Caen, France.
| | - Dinu Stefan
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France; Cyclhad, Normandy proton therapy center, 14000 Caen, France.
| | - Arthur Leclerc
- Neurosurgery Department, CHU Côte de nacre, 14000 Caen, France; Normandie Univ., UNICAEN, CNRS, ISTCT, GIP CYCERON, 14000 Caen, France.
| | - Evelyne Emery
- Neurosurgery Department, CHU Côte de nacre, 14000 Caen, France.
| | - Jeanne Riverain
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France; Cyclhad, Normandy proton therapy center, 14000 Caen, France.
| | - Fernand Missohou
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France; Cyclhad, Normandy proton therapy center, 14000 Caen, France.
| | - Julien Geffrelot
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France.
| | - William Kao
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France.
| | - Samuel Valable
- Normandie Univ., UNICAEN, CNRS, ISTCT, GIP CYCERON, 14000 Caen, France.
| | - Jacques Balosso
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France; Cyclhad, Normandy proton therapy center, 14000 Caen, France.
| | - Paul Lesueur
- François Baclesse Comprehensive Cancer Center, Radiation Oncology Department 14000 Caen, France; Cyclhad, Normandy proton therapy center, 14000 Caen, France; Centre de radiothérapie Guillaume le conquérant, 76600 Le Havre, France; Normandie Univ., UNICAEN, CNRS, ISTCT, GIP CYCERON, 14000 Caen, France.
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Jaspers JPM, Taal W, van Norden Y, Zindler JD, Swaak AT, Habraken SJM, Hoogeman MH, Nout R, van den Bent M, Méndèz Romero A. Early and late contrast enhancing lesions after photon radiotherapy for IDH mutated grade 2 diffuse glioma. Radiother Oncol 2023; 184:109674. [PMID: 37084885 DOI: 10.1016/j.radonc.2023.109674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The interpretation of new enhancing lesions after radiotherapy for diffuse glioma remains a clinical challenge. We sought to characterize and classify new contrast enhancing lesions in a historical multicenter cohort of patients with IDH mutated grade 2 diffuse glioma treated with photon therapy. METHODS We reviewed all follow-up MRI's of all patients treated with radiotherapy for histologically confirmed, IDH mutated diffuse grade 2 glioma between 1-1-2007 and 31-12-2018 in two tertiary referral centers. Disease progression (PD) was defined in accordance with the RANO criteria for progressive disease in low grade glioma. Pseudoprogression (psPD) was defined as any transient contrast-enhancing lesion between the end of radiotherapy and PD, or any new contrast-enhancing lesion that remained stable over a period of 12 months in patients who did not exhibit PD. RESULTS A total of 860 MRI's of 106 patients were reviewed. psPD was identified in 24 patients (23%) on 76 MRI's. The cumulative incidence of psPD was 13% at 1 year, 22% at 5 years, and 28% at 10 years. The mean of the observed maximal volume of psPD was 2.4cc. The median Dmin in psPD lesions was 50.1 Gy. The presence of an 1p/19q codeletion was associated with an increased risk of psPD (subhazard ratio 2.34, p=0.048). psPD was asymptomatic in 83% of patients. CONCLUSION The cumulative incidence of psPD in grade 2 diffuse glioma increases over time. Consensus regarding event definition and statistical analysis is needed for comparisons between series investigating psPD.
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Affiliation(s)
- J P M Jaspers
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - W Taal
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Y van Norden
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J D Zindler
- Department of Radiotherapy, Haaglanden Medisch Centrum, Leidschendam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| | - A T Swaak
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S J M Habraken
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| | - M H Hoogeman
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| | - M van den Bent
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A Méndèz Romero
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
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Heggebø LC, Borgen IMH, Rylander H, Kiserud C, Nordenmark TH, Hellebust TP, Evensen ME, Gustavsson M, Ramberg C, Sprauten M, Magelssen H, Blakstad H, Moorthy J, Andersson K, Raunert I, Henry T, Moe C, Granlund C, Goplen D, Brekke J, Johannessen TCA, Solheim TS, Marienhagen K, Humberset Ø, Bergström P, Agrup M, Dahl L, Gubanski M, Gojon H, Brahme CJ, Rydén I, Jakola AS, Vik-Mo EO, Lie HC, Asphaug L, Hervani M, Kristensen I, Rueegg CS, Olsen IC, Ledal RJ, Degsell E, Werlenius K, Blomstrand M, Brandal P. Investigating survival, quality of life and cognition in PROton versus photon therapy for IDH-mutated diffuse grade 2 and 3 GLIOmas (PRO-GLIO): a randomised controlled trial in Norway and Sweden. BMJ Open 2023; 13:e070071. [PMID: 36940951 PMCID: PMC10030923 DOI: 10.1136/bmjopen-2022-070071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION The use of proton therapy increases globally despite a lack of randomised controlled trials demonstrating its efficacy and safety. Proton therapy enables sparing of non-neoplastic tissue from radiation. This is principally beneficial and holds promise of reduced long-term side effects. However, the sparing of seemingly non-cancerous tissue is not necessarily positive for isocitrate dehydrogenase (IDH)-mutated diffuse gliomas grade 2-3, which have a diffuse growth pattern. With their relatively good prognosis, yet incurable nature, therapy needs to be delicately balanced to achieve a maximal survival benefit combined with an optimised quality of life. METHODS AND ANALYSIS PRO-GLIO (PROton versus photon therapy in IDH-mutated diffuse grade 2 and 3 GLIOmas) is an open-label, multicentre, randomised phase III non-inferiority study. 224 patients aged 18-65 years with IDH-mutated diffuse gliomas grade 2-3 from Norway and Sweden will be randomised 1:1 to radiotherapy delivered with protons (experimental arm) or photons (standard arm). First intervention-free survival at 2 years is the primary endpoint. Key secondary endpoints are fatigue and cognitive impairment, both at 2 years. Additional secondary outcomes include several survival measures, health-related quality of life parameters and health economy endpoints. ETHICS AND DISSEMINATION To implement proton therapy as part of standard of care for patients with IDH-mutated diffuse gliomas grade 2-3, it should be deemed safe. With its randomised controlled design testing proton versus photon therapy, PRO-GLIO will provide important information for this patient population concerning safety, cognition, fatigue and other quality of life parameters. As proton therapy is considerably more costly than its photon counterpart, cost-effectiveness will also be evaluated. PRO-GLIO is approved by ethical committees in Norway (Regional Committee for Medical & Health Research Ethics) and Sweden (The Swedish Ethical Review Authority) and patient inclusion has commenced. Trial results will be published in international peer-reviewed journals, relevant conferences, national and international meetings and expert forums. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05190172).
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Affiliation(s)
- Liv Cathrine Heggebø
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida Maria Henriksen Borgen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Kiserud
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Tonje Haug Nordenmark
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Taran Paulsen Hellebust
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Morten Egeberg Evensen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Section of Oncology, Drammen Hospital, Drammen, Norway
| | - Magnus Gustavsson
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medical Radiation Science, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Christina Ramberg
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Mette Sprauten
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Hanne Blakstad
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Janani Moorthy
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Ingela Raunert
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Henry
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medical Radiation Science, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Cecilie Moe
- Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Carin Granlund
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Dorota Goplen
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Jorunn Brekke
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | - Tora Skeidsvoll Solheim
- Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Øyvind Humberset
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
| | - Per Bergström
- Department of Oncology, University Hospital of Umeå, Umeå, Sweden
| | - Måns Agrup
- Department of Oncology, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ludvig Dahl
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Michael Gubanski
- Department of Radiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Gojon
- Department of Radiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Isabelle Rydén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Asgeir S Jakola
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Einar O Vik-Mo
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Asphaug
- Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Maziar Hervani
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Ingrid Kristensen
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Inge C Olsen
- Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | | | | | - Katja Werlenius
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Malin Blomstrand
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
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