Analysis of safety and efficacy of proton radiotherapy for IDH-mutated glioma WHO grade 2 and 3

• Published in: Journal of neuro-oncology 2023-05, Vol.162 (3), p.489-501
• Main Authors: Eichkorn, Tanja, Lischalk, Jonathan W., Hörner-Rieber, Juliane, Deng, Maximilian, Meixner, Eva, Krämer, Anna, Hoegen, Philipp, Sandrini, Elisabetta, Regnery, Sebastian, Held, Thomas, Harrabi, Semi, Jungk, Christine, Herfarth, Klaus, Debus, Jürgen, König, Laila
• Format: Article
• Language: English
• Subjects: Aged; Astrocytoma; Astrocytoma - pathology; Brain cancer; Brain Neoplasms - genetics; Brain Neoplasms - pathology; Brain Neoplasms - radiotherapy; Brain tumors; Case Study; Cognition; Complications; Glioma; Glioma - genetics; Glioma - radiotherapy; Humans; Isocitrate Dehydrogenase - genetics; Medicine; Medicine & Public Health; Mutation; Neurology; Oligodendroglioma; Oligodendroglioma - pathology; Oncology; Protons; Radiation therapy; Rice; World Health Organization
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-022-04217-y

Purpose Proton beam radiotherapy (PRT) has been demonstrated to improve neurocognitive sequelae particularly. Nevertheless, following PRT, increased rates of radiation-induced contrast enhancements (RICE) are feared. How safe and effective is PRT for IDH-mutated glioma WHO grade 2 and 3? Methods We analyzed 194 patients diagnosed with IDH-mutated WHO grade 2 (n = 128) and WHO grade 3 (n = 66) glioma who were treated with PRT from 2010 to 2020. Serial clinical and imaging follow-up was performed for a median of 5.1 years. Results For WHO grade 2, 61% were astrocytoma and 39% oligodendroglioma while for WHO grade 3, 55% were astrocytoma and 45% oligodendroglioma. Median dose for IDH-mutated glioma was 54 Gy(RBE) [range 50.4–60 Gy(RBE)] for WHO grade 2 and 60 Gy(RBE) [range 54–60 Gy(RBE)] for WHO grade 3. Five year overall survival was 85% in patients with WHO grade 2 and 67% in patients with WHO grade 3 tumors. Overall RICE risk was 25%, being higher in patients with WHO grade 2 (29%) versus in patients with WHO grade 3 (17%, p = 0.13). RICE risk increased independent of tumor characteristics with older age (p = 0.017). Overall RICE was symptomatic in 31% of patients with corresponding CTCAE grades as follows: 80% grade 1, 7% grade 2, 13% grade 3, and 0% grade 3 + . Overall need for RICE-directed therapy was 35%. Conclusion These data demonstrate the effectiveness of PRT for IDH-mutated glioma WHO grade 2 and 3. The RICE risk differs with WHO grading and is higher in older patients with IDH-mutated Glioma WHO grade 2 and 3.