PO.TB06.01 · 肿瘤生物学

质子与光子 VMAT 全脑全脊髓照射治疗血液系统软脑膜疾病：一项比较研究

Proton versus photon VMAT craniospinal irradiation for hematologic leptomeningeal disease: A comparative study

编号 7367 展板 4 时间 4/22 09:00–12:00 区域 Section 26 主讲 Brianna Hostler, No Degree

分会场 Biological Mechanisms of Tumor and Normal Tissue Response and Clinical Studies

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作者与单位 Authors & Affiliations

Brianna Hostler¹, Gene Lamanilao², Tam Le², Tara Austin³, Caitlin L. Costello⁴, Ah-Reum Jeong⁴, Kaitlyn Dykes⁴, Ayad Hamdan⁴, Nadeem Tabbara⁴, Iain Macewan², Jona A. Hattangadi-Gluth², Parag Sanghvi², Kathryn R. Tringale²

¹Department of Psychology, San Diego State University, San Diego, CA,²Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA,³Department of Psychiatry, University of California San Diego, La Jolla, CA,⁴Department of Medicine, University of California San Diego, La Jolla, CA

摘要 Abstract

中文摘要

全脑全脊髓照射（CSI）是治疗血液系统软脑膜疾病（LMD）的有效方案，LMD 是多种血液系统恶性肿瘤中一种颇具挑战性的病症。在血液系统 LMD 中，采用质子进行的 CSI（“pCSI”）与现代基于光子的容积调强弧形治疗（VMAT，即“xCSI”）之间的疗效比较尚未见报道。据推测，由于在保护骨髓方面具有更有利的剂量分布，pCSI 相较于 xCSI 可能降低血液学毒性。本研究比较了 xCSI 与 pCSI 的急性毒性和生存情况，假设 xCSI 毒性更高，但在校正体能状态后生存相似。识别出 2020 至 2025 年间接受 CSI 治疗的成人血液系统 LMD 患者。急性血液学毒性在基线、治疗期间以及 CSI 后 1 个月和 3 个月采用 CTCAE v.5.0 分级。总生存期（OS）和中枢神经系统无进展生存期（CNS-PFS）分别从 CSI 结束至死亡和进展事件采用 Kaplan-Meier 法评估。OS 进一步采用校正 ECOG 体能状态的 Cox 比例风险模型进行分析。在 34 例患者（中位年龄 38 岁）中，26 例（76%）接受 xCSI，8 例（24%）接受 pCSI。所给予的放射剂量范围为 7.2 Gy-30.6 Gy，分 4-17 次。pCSI 与 xCSI 组间基线临床人口学变量相似：多数患者 ECOG 评分为 1（p=.802），急性淋巴细胞白血病（58.8%）和非霍奇金淋巴瘤（17.6%）为最常见的组织学类型（p=.517）。xCSI 期间≥3 级淋巴细胞减少显著更高（p=0.006），但在 CSI 后 1 个月随访时消退（p=.202）。未观察到其他急性血液学毒性的显著差异。中位 OS 为 28.3 个月，组间无显著差异（28.26 个月；95%CI，21.19-35.33；p=.228），在校正 ECOG 后仍不显著（HR 0.16；95% CI，0.02-1.45；p=.103）。中位 CNS-PFS 未达到（p=.212）。在血液系统 LMD 中，pCSI 与 xCSI 显示出相似的生存和急性血液学毒性特征，支持 VMAT xCSI 的安全性。然而，接受 xCSI 的患者更可能发生严重淋巴细胞减少，对于常有骨髓脆弱的血液系统恶性肿瘤患者而言，这是一个尤为相关的终点。这些数据对于补充现有关于实体瘤 LMD 的 CSI 文献具有重要意义，因为血液系统恶性肿瘤是尤为高危的人群。尽管本研究受限于队列规模较小和患者选择，但它是优化血液系统 LMD 管理的重要第一步。

查看英文原文 English abstract

Craniospinal irradiation (CSI) is an effective treatment option in the treatment of hematologic leptomeningeal disease (LMD), a challenging condition seen in a variety of hematologic malignancies. Comparative outcomes between CSI delivered with protons (“pCSI”) versus modern photon-based volumetric modulated arc therapy (VMAT, or “xCSI”) have not been described in hematologic LMD. It is hypothesized that pCSI may reduce hematologic toxicity compared to xCSI due to the more favorable dose distribution regarding bone marrow sparing. This study compares acute toxicities and survival between xCSI and pCSI, hypothesizing higher toxicity with xCSI but similar survival after adjusting for performance status. Adult hematologic LMD patients treated with CSI between 2020 and 2025 were identified. Acute hematologic toxicities were graded using CTCAE v.5.0 at baseline, during treatment, and at 1- and 3-months post-CSI. Overall survival (OS) and CNS progression-free survival (CNS-PFS) were evaluated from CSI end to death and progression event, respectively, using Kaplan-Meier. OS was further analyzed using Cox proportional hazards models adjusted for ECOG performance status. Of 34 patients (median age 38), 26 (76%) received xCSI and 8 (24%) received pCSI. The delivered radiation dose ranged from 7.2 Gy-30.6 Gy in 4-17 fractions. Baseline clinicodemographic variables were similar between pCSI and xCSI: most patients had an ECOG score of 1 (p=.802), and acute lymphoblastic leukemia (58.8%) and non-Hodgkin lymphoma (17.6%) were the most common histologies (p=.517). Grade ≥3 lymphopenia was significantly higher during xCSI (p=0.006) but resolved by the 1-month post-CSI follow-up (p=.202). No other significant differences in acute hematologic toxicities were observed. Median OS was 28.3 months and did not significantly differ between the groups (28.26m; 95%CI, 21.19-35.33; p=.228) and remained nonsignificant after adjustment for ECOG (HR 0.16; 95% CI, 0.02-1.45; p=.103). Median CNS-PFS was not reached (p=.212). pCSI and xCSI demonstrated similar survival and acute hematologic toxicity profiles in hematologic LMD, supporting the safety of VMAT xCSI. However, patients who received xCSI were more likely to have severe lymphopenia, which is a particularly relevant endpoint for patients with hematologic malignancies who often have vulnerable bone marrow. These data are important to add to the existing literature on CSI for solid tumor LMD, as hematologic malignancies are a particularly at-risk population. While this study is limited by small cohort size and patient selection, it is an important first step toward optimizing the management of hematologic LMD.

利益披露 Disclosure

B. Hostler, None.. G. Lamanilao, None.. T. Le, None.. T. Austin, None.. C. L. Costello, None.. A. Jeong, None.. K. Dykes, None.. A. Hamdan, None.. N. Tabbara, None.. I. Macewan, None.. J. A. Hattangadi-Gluth, None.. P. Sanghvi, None.. K. R. Tringale, None.

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