Clinical trial of proton craniospinal irradiation for leptomeningeal metastases Journal Article
| Authors: | Yang, T. J.; Wijetunga, N. A.; Yamada, J.; Wolden, S.; Mehallow, M.; Goldman, D. A.; Zhang, Z.; Young, R. J.; Kris, M. G.; Yu, H. A.; Seidman, A. D.; Gavrilovic, I. T.; Lin, A.; Santomasso, B.; Grommes, C.; Piotrowski, A. F.; Schaff, L.; Stone, J. B.; DeAngelis, L. M.; Boire, A.; Pentsova, E. |
| Article Title: | Clinical trial of proton craniospinal irradiation for leptomeningeal metastases |
| Abstract: | BACKGROUND: Leptomeningeal metastases (LM) are associated with limited survival and treatment options. While involved-field radiotherapy is effective for local palliation, it lacks durability. We evaluated the toxicities of proton craniospinal irradiation (CSI), a treatment encompassing the entire central nervous system (CNS) compartment, for patients with LM from solid tumors. METHODS: We enrolled patients with LM to receive hypofractionated proton CSI in this phase I prospective trial. The primary endpoint was to describe treatment-related toxicity, with dose-limiting toxicity (DLT) defined as any radiation-related grade 3 non-hematologic toxicity or grade 4 hematologic toxicity according to the Common Terminology Criteria for Adverse Events that occurred during or within 4 weeks of completion of proton CSI. Secondary endpoints included CNS progression-free survival (PFS) and overall survival (OS). RESULTS: We enrolled 24 patients between June 2018 and April 2019. Their median follow-up was 11 months. Twenty patients were evaluable for protocol treatment-related toxicities and 21 for CNS PFS and OS. Two patients in the dose expansion cohort experienced DLTs consisted of grade 4 lymphopenia, grade 4 thrombocytopenia, and/or grade 3 fatigue. All DLTs resolved without medical intervention. The median CNS PFS was 7 months (95% CI: 5-13) and the median OS was 8 months (95% CI: 6 to not reached). Four patients (19%) were progression-free in the CNS for more than 12 months. CONCLUSION: Hypofractionated proton CSI using proton therapy is a safe treatment for patients with LM from solid tumors. We saw durable disease control in some patients. © The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. |
| Keywords: | proton radiation; leptomeningeal metastases; craniospinal irradiation |
| Journal Title: | Neuro-Oncology |
| Volume: | 23 |
| Issue: | 1 |
| ISSN: | 1522-8517 |
| Publisher: | Oxford University Press |
| Date Published: | 2021-01-01 |
| Start Page: | 134 |
| End Page: | 143 |
| Language: | English |
| DOI: | 10.1093/neuonc/noaa152 |
| PUBMED: | 32592583 |
| PROVIDER: | scopus |
| PMCID: | PMC7850116 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2021 -- Source: Scopus |
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