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Proton radiotherapy in the treatment of IDH-mutant diffuse gliomas: an early experience from shanghai proton and heavy ion center

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Abstract

Purpose

According to the presence or absence of isocitrate dehydrogenase (IDH) mutation, the 2021 WHO classification system bisected diffuse gliomas into IDH-mutant tumors and IDH-wildtype tumors. This study was aimed to evaluate the outcomes of proton radiotherapy treating IDH-mutant diffuse gliomas.

Patients and Methods

Between May 2015 and May 2022, a total of 52 consecutive patients with IDH-mutant diffuse gliomas were treated at Shanghai Proton and Heavy Ion Center. Tumor histologies were 33 cases of astrocytoma and 19 cases of oligodendroglioma. Tumor classified by WHO grade 2, 3 and 4 were 22, 25, and 5 cases, respectively. All 22 patients with WHO grade 2 tumors and one patient with brain stem WHO grade 4 tumor were irradiated with 54GyE. The other 29 patients with WHO grade 3 and 4 tumors were irradiated with 60GyE. Temozolomide was recommended to all patients, and was eventually conducted in 50 patients.

Results

The median follow-up time was 21.7 months. The 12/24-month progression-free survival (PFS) and overall survival (OS) rates for the entire cohort were 97.6%/78.4% and 100%/91.0% group. Examined by both univariate and multivariate analysis, WHO grade of tumor were of the most significant impact for both PFS and OS. No severe acute toxicity (grade 3 or above) was found. In terms of late toxicity, grade 3 radio-necrosis was developed in one case of oligodendroglioma, WHO grade 3.

Conclusion

Proton radiotherapy produced a favorable outcome with acceptable adverse-effects in patients with IDH-mutant diffuse gliomas.

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Data availability

The datasets generated during and/or analyzed during the present study are available from the corresponding author on reasonable request.

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Funding

Shanghai Municipal Health Commission Special Clinical Research Project (Project No. 20204Y0281, 202040295).

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Authors and Affiliations

  1. Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China

    Xianxin Qiu, Jing Gao, Jiyi Hu, Jing Yang, Weixu Hu, Qingting Huang & Haojiong Zhang

  2. Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China

    Xianxin Qiu, Jing Gao, Jiyi Hu, Jing Yang, Weixu Hu, Qingting Huang, Haojiong Zhang & Lin Kong

  3. Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China

    Xianxin Qiu, Jing Gao, Jiyi Hu, Jing Yang, Weixu Hu, Qingting Huang, Haojiong Zhang & Lin Kong

  4. Tumor, Proton and Heavy Ion Center, Heyou International Hospital, Guangdong, China

    Jiade J. Lu

  5. Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hosptial, 4365 Kangxin Road, Pudong, Shanghai, 201315, China

    Lin Kong

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Conception and design: LK, JL. Acquisition of data: XQ, JG, JH, JY, WH, QH, HZ. Analysis and interpretation of data: XQ, JG. Drafting or revising the article: XQ, LK.

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Qiu, X., Gao, J., Hu, J. et al. Proton radiotherapy in the treatment of IDH-mutant diffuse gliomas: an early experience from shanghai proton and heavy ion center. J Neurooncol 162, 503–514 (2023). https://doi.org/10.1007/s11060-022-04202-5

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